利妥昔单抗治疗儿童难治性激素耐药肾病综合征致心律失常1例并文献复习  

Arrhythmia Induced by Rituximab Treatment for Refractory Steroid-Resistant Nephrotic Syndrome in Children:a Case Report and Literature Review

作　　者：张璇[1] 崔广梅[1] 班洪芳 辛丹丹[1] 王一冰[1] 孙清[1] Zhang Xuan;Cui Guangmei;Ban Hongfang;Xin Dandan;Wang Yibing;Sun Qing(Women and Children’s Hospital Affiliated to Qingdao University,Shandong Qingdao 266000,China)

机构地区：[1]青岛大学附属妇女儿童医院,山东青岛266000

出　　处：《儿科药学杂志》2024年第11期37-41,共5页Journal of Pediatric Pharmacy

摘　　要：目的:总结1例应用利妥昔单抗治疗难治性激素耐药肾病综合征并导致心律失常患儿的临床特点及诊治经过并进行文献复习。方法:回顾性分析青岛大学附属妇女儿童医院肾脏免疫科收治的1例难治性激素耐药肾病综合征患儿的临床诊疗及随访过程,并以“利妥昔单抗”“心律失常”“rituximab”“arrhythmia”为检索词,检索建库至2023年5月中国知网、万方及PubMed数据库进行文献复习。结果:患儿,男,发病年龄3岁,肾病综合征病史3年,无心血管基础疾病。患儿初治激素耐药,他克莫司敏感但减至小剂量出现频复发及激素依赖,予利妥昔单抗每次100 mg,每周1次,应用第3次后患儿出现心律不齐,心电图示窦性心律不齐、室上性早搏、室上性早搏伴室内差传。之后每月监测心电图或动态心电图,至今随访8个月,较前无明显变化。文献复习显示应用利妥昔单抗出现循环系统不良反应发生率5%~8%,包括各种心律失常,如房颤、室性或室上性心动过速、期前收缩、心动过缓等。在非肿瘤疾病中应用利妥昔单抗治疗后出现心血管不良事件个案报道8篇文献,加上本例共10例患者,(2例儿童,8例成人),6例无心血管疾病史,9例出现心电图改变,随访仅4例恢复。结论:随着利妥昔单抗应用范围的扩大,医师必须意识到该药有致严重的心血管不良反应风险。建议应用利妥昔单抗治疗前后进行心电图、心脏超声监测,以便及时发现并应对心律失常等心血管不良事件。Objective:To summarize the clinical characteristics,diagnosis and treatment of a child with arrhythmia induced by rituximab treatment for refractory steroid-resistant nephrotic syndrome,and to review the literature.Methods:The clinical diagnosis,treatment and follow-up process of the child with refractory steroid-resistant nephrotic syndrome admitted into the Department of Renal Immunization in Women and Children’s Hospital Affiliated to Qingdao University was retrospectively summarized.“Rituximab”“arrhythmia”in Chinese and English were respectively selected from CNKI,Wanfang and PubMed databases up to May 2023,and literature review was performed.Results:The patient was a 3-year-old male with a 3-year history of nephrotic syndrome and no underlying cardiovascular disease.After initial treatment,the patient was steroid resistant,tacrolimus sensitive but reduced to a low dose,which resulted in frequent recurrence and steroid dependence.Rituximab was given 100 mg each time,once a week,and arrhythmia occurred after the third application.Electrocardiogram showed sinus arrhythmia,supraventricular premature beat,and supraventricular premature beat with aberrant ventricular conduction.Electrocardiogram or holter electrocardiogram was monitored monthly and followed up for 8 months,with no significant change compared with before.The incidence of circulatory adverse drug reactions of rituximab was 5%to 8%,including various arrhythmias,for example atrial fibrillation,supraventricular or ventricular tachycardia,prephase systole,and bradycardia.Cardiovascular adverse events after rituximab treatment in non-tumor diseases were reported in 8 literature,with a total of 10 patients(including the child in this case),there were 2 children and 8 adults,6 patients with no history of cardiovascular disease,9 patients with electrocardiogram changes,and only 4 patients recovered during follow-up.Conclusion:With the application expansion of rituximab,clinicians must be aware of the risk of severe cardiovascular adverse events.It

关 键 词：利妥昔单抗 肾病综合征 激素耐药 心律失常 

分 类 号：R725.9[医药卫生—儿科]