李小伟, 郭凯琦, 徐丽, 黄兰兰, 李慧敏. 低剂量利妥昔单抗治疗成人激素依赖微小病变肾病综合征的疗效[J]. 临床肾脏病杂志, 2021, 21(9): 727-732. DOI: 10.3969/j.issn.1671-2390.2021.09.005
    引用本文: 李小伟, 郭凯琦, 徐丽, 黄兰兰, 李慧敏. 低剂量利妥昔单抗治疗成人激素依赖微小病变肾病综合征的疗效[J]. 临床肾脏病杂志, 2021, 21(9): 727-732. DOI: 10.3969/j.issn.1671-2390.2021.09.005
    Li Xiao-wei, Guo Kai-qi, Xu Li, Huang Lan-lan, Li Hui-min. Therapeutic efficacy of low-dose rituximab for steroid-dependent minimal-change nephrotic syndrome in adults[J]. Journal of Clinical Nephrology, 2021, 21(9): 727-732. DOI: 10.3969/j.issn.1671-2390.2021.09.005
    Citation: Li Xiao-wei, Guo Kai-qi, Xu Li, Huang Lan-lan, Li Hui-min. Therapeutic efficacy of low-dose rituximab for steroid-dependent minimal-change nephrotic syndrome in adults[J]. Journal of Clinical Nephrology, 2021, 21(9): 727-732. DOI: 10.3969/j.issn.1671-2390.2021.09.005

    低剂量利妥昔单抗治疗成人激素依赖微小病变肾病综合征的疗效

    Therapeutic efficacy of low-dose rituximab for steroid-dependent minimal-change nephrotic syndrome in adults

    • 摘要: 目的 观察低剂量利妥昔单抗(rituximab,RTX)预防成人激素依赖微小病变肾病综合征(steroid-dependent minimal change nephritic syndrome,SDMCNS)复发的疗效。方法 回顾性分析2018年11月至2019年12月我院收治且随访时间大于18个月的接受低剂量RTX治疗的8例SDMCNS患者临床检验资料。结果 (1)8例患者应用RTX时中位年龄28.5(18~53)岁,在中位24.5(18~28)个月随访中分别有5例、3例间歇使用RTX 0.375 g/m2 2剂、3剂。(2)所有患者一年内无复发,其中4例监测CD19+B细胞数增加至绝对值大于6个/μL时重复使用RTX 0.375 g/m2的SDMCNS患者,至随访期末复发。(3)对比RTX治疗前后一年临床资料发现,8例患者经RTX治疗后激素应用量减少,随访期末维持7.5(0~20)mg/d,其中2例患者停用激素,且复发次数、住院次数及并发症均显著减少。(4)8例患者应用RTX后,除1例患者出现皮疹及皮肤瘙痒外,其余患者无明显不良反应。结论 低剂量RTX治疗成人SDMCNS,在监测CD19+B细胞数基础上重复使用RTX,可减少复发同时减少经济支出,且不良反应少。

       

      Abstract: Objective To explore the therapeutic efficacy of low-dose rituximab(RTX) for a relapse of steroid-dependent minimal-change nephrotic syndrome(SDMCNS) in adults. Methods From November 2018 to December 2019, 8 male SDMCNS patients were retrospectively analyzed. They received low-dose RTX treatment and were followed up for over 18 months. Results The median age was 28.5(18-53) years and the median follow-up period 24.5(18-28) months. And 5 and 3 cases received 2 and 3 intermittent doses of RTX 0.375 g/m2 respectively. None of them had a relapse within 1 year. RTX 0.375 g/m2 was repeated for 4 cases when CD19+ B-cell count dropped to 6. No relapse occurred at the end of follow-up period. A comparison of clinical data at 1 year before and after RTX dosing, hormone dose declined. At the end of follow-up period, the maintenance dose was 7.5(0-20) mg/d. Two discontinued horome and frequency of relapse/hospitalization and incidence of complications decreased markedly. Except for skin rash and pruritus in one case, the remainders had no obvious adverse effects. Conclusion For SDMCNS in adults, using low-dose RTX may be repeated based upon monitoring CD19+ B-cell count. Such a regimen may lower the frequency of relapse and reduce economic expenditures with fewer side effects.

       

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