利妥昔单抗在难治性微小病变型肾病综合征中的疗效及分析

目的回顾性分析利妥昔单抗(rituximab,RTX)治疗难治性微小病变型肾病综合征(minimal-change nephrotic syndrome,MCNS)的疗效和安全性,探讨影响其疗效的可能因素。方法纳入2018年12月至2020年6月于我院肾内科接受RTX治疗的MCNS患者23例,根据发病年龄分为儿童组(n=12)和成人组(n=11),比较2组临床特征、实验室指标及预后差异,并探讨可能影响RTX疗效的因素。结果相较于儿童组,RTX治疗前成人组淋巴细胞、血小板计数、血红蛋白浓度更低(P=0.019、0.015、0.039),血清补体C3水平更高(P=0.036)。治疗前6个月,儿童及成人组复发次数分别为1.50±0.67次和1.27±0.47次,治疗后6个月分别有7例(58.3%)和6例(54.5%)停药,7例(58.3%)和7例(63.6%)完全缓解,3例(25.0%)和1例(9.1%)复发。RTX治疗后2组血清白蛋白均升高(P=0.007、0.012),尿蛋白肌酐比值(P=0.046、0.018),血清肌酐(P=0.017、0.043)及总胆固醇(P=0.001、0.009)水平降低。COX回归多因素分析显示RTX治疗激素依赖/频繁复发型MCNS能减少患者尿蛋白复发风险(P=0.051,OR=0.157,95%CI:0.024~1.008)。结论利妥昔单抗对儿童与成人难治性MCNS均具有显著疗效。

Efficacy and safety of rituximab in treatment of refractory minimalchange nephrotic syndrome

To investigate the efficacy and safety of rituximab(RTX)in the treatment of refractory minimalchange nephrotic syndrome(MCNS)and to explore the possible factors influencing the therapeutic effect of RTX,23 patients with MCNS who received RTX treatment were included.The patients were divided into the childhood-onset group(n=12)and the adult-onset group(n=11)according to onset age.The difference of clinical features between two groups were compared using the two independent sample t test or rank-sum test.Compared with the patients in childhood-onset group,the patients in adult-onset group had lower levels of lymphocyte platelet count and hemoglobin(P=0.019,0.015,0.039),but higher serum levelof complement 3(C3)(P=0.036).Six months before RTX treatment,the times of relapse were 1.50±0.67(childhood-onset)and 1.27±0.47(adult-onset),while at 6 months after RTX,there were 7 patients(58.3%)got to complete remission and 3 patients(25.0%)relapsed in childhoodonset group,and 7 patients(63.6%)got to complete remission and 1 patient(9.1%)relapsedin adult-onset group.After treatment,serum albumin levels were increased in both groups(P=0.007,0.012),urine protein/creatinine ratio were significantly decreased(P=0.046,0.018),and the levels of serum creatinine(P=0.017,0.043)and total cholesterol(P=0.001,0.009)were decreased.COX regression analysis showed that steroids-dependent/frequentlyrelapsing nephrotic syndrome may reduce the risk of urinary protein relapse in patients with MCNS(P=0.051,OR=0.157,95%CI:0.024-1.008).In conclusion,rituximab is significant effective for patients with refractory MCNS in children and adults.