利妥昔单抗联合环磷酰胺治疗重症狼疮性肾炎的效果分析  

Therapeutic effect of rituximab combined with cyclophosphamide on severe lupus nephritis

作　　者：陈景荷[1] 张艳琴[2] 李文冬[2] 李文魁 Chen Jinghe;Zhang Yanqin;Li Wendong;Li Wenkui(Department of Critical Care Medicine,Baoji People’s Hospital,Baoji 721000,China;Department of Nephrology,Baoji People’s Hospital,Baoji 721000,China;Department of Traditional Chinese Medicine,Affiliated Baoji Hospital of Xi’an Medical University,Baoji 721006,China)

机构地区：[1]宝鸡市人民医院重症医学科,宝鸡721000 [2]宝鸡市人民医院肾病内科,宝鸡721000 [3]西安医学院附属宝鸡医院中医科,宝鸡721006

出　　处：《中国实用医刊》2024年第24期78-81,共4页Chinese Journal of Practical Medicine

基　　金：陕西省自然科学基础研究计划(2023-JC-YB-644)。

摘　　要：目的分析利妥昔单抗联合环磷酰胺治疗重症狼疮性肾炎(LN)的效果及安全性。方法抽取2020年8月至2023年7月宝鸡市人民医院收治的80例LN患者为研究对象, 回顾性分析其临床资料, 根据治疗方案将纳入患者分为对照组(38例, 予以环磷酰胺治疗)与联合组(42例, 予以环磷酰胺+利妥昔单抗治疗)。比较两组疗效、生化指标(24 h尿蛋白、血肌酐、白蛋白)、T细胞亚群(CD4^(+)、CD4^(+)/CD8^(+)、CD3^(+)、CD8^(+))、炎症相关指标[CXC趋化因子配体9(CXCL9)、CXC趋化因子配体16(CXCL16)、白细胞介素-17(IL-17)、C反应蛋白(CRP)]水平及不良反应。结果联合组总缓解率(88.10%, 37/42)高于对照组(68.42%, 26/38), P<0.05。治疗6个月后, 两组24 h尿蛋白、血肌酐、CD8^(+)、CXCL9、CXCL16、IL-17、CRP水平低于治疗前, 且联合组低于对照组(P<0.05)。治疗6个月后, 两组白蛋白、CD4^(+)、CD4^(+)/CD8^(+)、CD3^(+)水平高于治疗前, 且联合组高于对照组(P<0.05)。两组不良反应发生率比较差异未见统计学意义(P>0.05)。结论利妥昔单抗联合环磷酰胺治疗重症LN安全有效, 可改善T细胞亚群, 抑制炎性反应, 改善肾功能, 提高缓解率。Objective To analyze the efficacy and safety of rituximab combined with cyclophosphamide in the treatment of severe lupus nephritis(LN).MethodsEighty patients with LN treated in Baoji People’s Hospital from August 2020 to July 2023 were selected as research objects,and their clinical data were retrospectively analyzed.And they were divided into the control group(38 cases,treated with cyclophosphamide)and the combination group(42 cases,treated with cyclophosphamide+rituximab)according to treatment regimen.The curative effect,biochemical indexes,including 24-hour urinary protein,serum creatinine and albumin,T cell subsets,including cluster of differentiation 4+(CD4^(+)),CD4^(+)/cluster of differentiation 8+(CD8^(+)),cluster of differentiation 3+(CD3^(+))and CD8^(+),levels of inflammation related indicators,including C-X-C motif chemokine ligand 9(CXCL9),C-X-C motif chemokine ligand 16(CXCL16),interleukin 17(IL-17)and C-reactive protein(CRP),and adverse reactions were compared between the two groups.ResultsThe total remission rate of the combination group(88.10%,37/42)was higher than that of the control group(68.42%,26/38),P<0.05.After 6 months of treatment,the levels of 24-hour urinary protein,serum creatinine,CD8^(+),CXCL9,CXCL16,IL-17 and CRP in the two groups were lower than those before treatment,and the above indexes in the combination group were lower than those in the control group(P<0.05).After 6 months of treatment,the levels of albumin,CD4^(+),CD4^(+)/CD8^(+),and CD3^(+)in the two groups increased,and the combination group had higher levels than the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).ConclusionsRituximab combined with cyclophosphamide is safe and effective in the treatment of severe LN,which can improve T cell subsets,inhibit inflammatory response,improve renal function,and increase the remission rate.

关 键 词：利妥昔单抗 环磷酰胺 狼疮性肾炎 尿蛋白 T细胞亚群 

分 类 号：R73[医药卫生—肿瘤]