摘要
目的探讨低剂量利妥昔单抗(rituximab,RTX)治疗难治性特发性膜性肾病(idiopathic membranous nephropathy,IMN)的有效性及安全性。方法回顾性收集2017年1月至2018年12月诊断的难治性IMN且抗磷脂酶A2受体(PLA2R)抗体阳性病例32例,接受低剂量RTX治疗方案,收集随访1年的临床资料。结果低剂量RTX治疗难治性IMN总体有效率为87.50%,其中完全缓解率62.50%,部分缓解率25.00%;低剂量RTX治疗后能显著降低CD19^(+)B细胞、血清总IgG及抗PLA2R抗体水平(P<0.05),且病情缓解程度与抗PLA2R抗体水平密切相关。低剂量RTX治疗不良反应包括粒细胞缺乏症2例、输注中低血压2例及非重症肺部感染1例。结论低剂量利妥昔单抗治疗难治性IMN的有效性好,安全性较好。进一步明确针对“B细胞-抗PLA2R抗体-免疫损伤”环节的干预在难治性IMN治疗中的重要地位。
Objective To explore the efficacy and safety of low-dose rituximab(RTX)for refractory idiopathic membranous nephropathy(IMN).Methods From January 2017 to December 2018,32 cases of refractory IMN with positive anti-PLA2R antibody were collected.They received low-dose RTX treatment and were followed up for 1 year.Results The overall effective rate of low-dose RTX treatment for refractory IMN was 87.50%with a complete remission rate of 62.50%and a partial remission rate of 25.00%.After low-dose RTX treatment,CD19^(+)B cell count,serum levels of total IgG and anti-PLA2R antibody declined markedly(P<0.05)and disease severity was closely correlated with anti-PLA2R antibody level.Adverse reactions of low-dose RTX treatment included agranulocytosis(n=2),hypotension during infusion(n=2)and pulmonary infection(n=1).Conclusion Low-dose rituximab is both effective and safe for refractory IMN.
作者
袁仲飞
刘先燕
何剑
Yuan Zhong-fei;Liu Xian-yan;He Jian(Department of Nephrology,Kaizhou District People's Hospital,Chongqing 405400,China;Department of Electrophysiology,Kaizhou District People's Hospital,Chongqing 405400,China)
出处
《临床肾脏病杂志》
2021年第3期215-219,共5页
Journal Of Clinical Nephrology
