利妥昔单抗治疗儿童初发激素敏感型肾病综合征的疗效  

Efficiency of Rituximab for the treatment of the initial episode of steroid-sensitive nephrotic syndrome in children

作　　者：袁婷婷 朱冰冰 李艳 彭倩倩 杨焕丹 陈娜 仲召文 张锐锋 Yuan Tingting;Zhu Bingbing;Li Yan;Peng Qianqian;Yang Huandan;Chen Na;Zhong Zhaowen;Zhang Ruifeng(Department of Intrarenal Rheumatism and Immunology,Xuzhou Children′s Hospital,Xuzhou 221006,China)

机构地区：[1]徐州市儿童医院肾脏风湿免疫科,徐州221006

出　　处：《中华实用儿科临床杂志》2025年第2期125-129,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：徐州市重点研发计划(社会发展)项目(KC22199);徐州市儿童医院院级科研项目(22040413)。

摘　　要：目的分析利妥昔单抗(RTX)联合短疗程糖皮质激素治疗初发激素敏感型肾病综合征(SSNS)的疗效及安全性。方法回顾性病例总结。选择2021年12月至2023年3月在徐州市儿童医院肾脏风湿免疫科接受治疗的30例初发SSNS患儿为研究对象, 给予1剂标准剂量RTX(375 mg/m^(2)), 联合短疗程糖皮质激素, 随访1年, 记录患儿的一般情况、RTX治疗前后CD19+B细胞变化、复发率、中位无复发生存时间、RTX不良反应。采用Kaplan-Meier法分析无复发生存时间。结果应用RTX后2周均能使B细胞耗竭, 应用RTX后B细胞重建的中位时间为5个月。1年无复发率为90.00%, 中位无复发生存期为11个月。应用RTX 3个月糖皮质激素停用率达93.33%, 应用RTX 6个月及12个月糖皮质激素停用率均达100%。7例(23.33%)在RTX输注中出现输液反应, 5例(16.67%)出现中性粒细胞/白细胞减少, 10例(33.33%)有低免疫球蛋白血症, 4例(13.33%)出现感染, 其中1例在B细胞重建后合并重症甲型流感病毒感染, 余未见明显不良反应。结论标准剂量RTX治疗初发型SSNS, 可显著减少其复发次数, 维持较长时间蛋白尿缓解, 减少糖皮质激素使用剂量, 无明显不良反应, 适合临床推广。Objective To evaluate the efficacy and safety of Rituximab(RTX)combined with short-term use of glucocorticoids in the treatment of the initial episode of steroid-sensitive nephrotic syndrome(SSNS).Methods A retrospective case summary.A total of 30 children with SSNS treated in the Department of Intrarenal Rheumatism and Immunology,Xuzhou Children′s Hospital from December 2021 to March 2023,were enrolled in this study.They were given a standard dose of RTX(375 mg/m^(2))and glucocorticoids for a short term.The patients were followed up for 1 year,and the general condition,changes in CD19+B lymphocytes expression after RTX treatment,the relapse rate,the median relapse-free survival and adverse reactions of RTX were recorded.Kaplan-Meier method was used to analyze the relapse-free survival time.Results CD19+B lymphocytes were depleted 2 weeks after RTX treatment,and the median time required for CD19+B lymphocytes reconstitution was 5 months after RTX treatment.The 1-year relapse-free rate was 90.00%,and the median relapse-free survival was 11 months.The glucocorticoid discontinuation rate was 93.33%in 3 months after RTX treatment,and 100%in 6 and 12 months after RTX treatment.Adverse reactions included infusion reactions in 7 cases(23.33%),neutropenia/leukopenia in 5 cases(16.67%),hypoimmunoglobulinemia in 10 cases(33.33%),infections in 4 cases.One case was complicated with severe influenza A virus infection after CD19+B lymphocytes reconstruction.Conclusions A standard dose of RTX can significantly reduce the relapse frequency,maintain long-term remission of proteinuria,and reduce the dose of glucocorticoids in patients at the initial episode of SSNS.Thus,it is worthy of clinical promotion.

关 键 词：儿童 利妥昔单抗 初发肾病综合征 激素敏感 

分 类 号：R72[医药卫生—儿科]