低剂量利妥昔单抗治疗难治性特发性膜性肾病的临床疗效分析

袁仲飞; 刘先燕; 何剑

doi:10.3969/j.issn.1671-2390.y20-035

低剂量利妥昔单抗治疗难治性特发性膜性肾病的临床疗效分析

Clinical analysis of low-dos erituximab in the treatment of refractory idiopathic membranous nephropathy

摘要

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。

Abstract: 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.

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