摘要
目的探讨利妥昔单抗对常规治疗儿童系统性红斑狼疮合并狼疮性肾炎后再次出现免疫学指标异常(dsDNA、ANA回升),但无临床狼疮活动症状的患儿进行耗竭B细胞治疗,观察狼疮免疫学指标恢复及临床控制情况。方法5例儿童系统性红斑狼疮合并狼疮性肾炎治疗后再次出现免疫学指标异常的患儿,予静脉注射利妥昔单抗375 mg/m2,于治疗前及治疗后评估T、B淋巴细胞亚群、dsDNA、ANA、补体、尿蛋白情况,并监测不良反应。结果5例患儿予输注利妥昔单抗治疗后,5例患儿2周内B细胞均降为0%。4例dsDNA、ANA较前下降,补体C3、C4较前上升。3例患儿糖皮质激素、免疫抑制剂减量。5例患儿均无明显不良反应。结论系统性红斑狼疮并狼疮性肾炎患儿经规范治疗后,再次出现免疫学指标异常,但临床活动性指标大致正常,在不增加糖皮质激素及免疫抑制剂用量情况下,应用利妥昔单抗能安全控制免疫学异常指标,又不增加糖皮质激素及免疫抑制剂的剂量,为维持系统性红斑狼疮并狼疮性肾炎长期缓解提供治疗新思路。
Objective To investigate efficacy and safety of rituximab therapy on children with systemic lupus erythematosus(SLE)complicated with lupus nephritis,who showed immunological index abnormalities(the level of dsDNA,ANA rebounded)with no clinical lupus activity symptoms.Methods Rituximab treatment was given to 5 children with SLE complicated with lupus nephritis.T lymphocytes and B lymphocytes subsets,dsDNA,ANA,complement and the level of urine protein were evaluated.The adverse reactions were also monitored.Results The percentage of B cells in 5 cases all decreased to 0%in 2 weeks after the injection of rituximab.The level of dsDNA and ANA decreased and complement C3 and C4 increased in 4 cases.Steroid and immunosuppressant were reduced in 3 cases.In addition,there was no significant adverse reaction in all the 5 cases.Conclusion For the children with SLE complicated with lupus nephritis,the application of rituximab can safely control the immunological abnormalities,without increase the side effects of steroid immunosuppressant.This treatment provides a novel idea for maintaining the long-term remission of SLE with lupus nephritis.
作者
温晓莹
肖慧捷
王芳
苏白鸽
WEN Xiao-ying;XIAO Hui-jie;WANG Fang;SU Bai-ge(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China)
出处
《广东医学》
CAS
2020年第8期831-834,共4页
Guangdong Medical Journal
基金
全国名老中医药专家传承工作室建设项目(粤中医办[2013]88号)。
