摘要
目的探讨极低剂量利妥昔单抗治疗原发性难治性肾病综合征的疗效及对肾功能、免疫球蛋白、Toll样受体(toll-like receptors,TLRs)的影响。方法选取2017年3月至2020年2月武警安徽省总队医院肾内科72例原发性难治性肾病综合征患者作为研究对象,采用随机数字表法分为3组,每组24例。A组予以极低剂量利妥昔单抗(100 mg/m2),B组予以标准剂量利妥昔单抗(375 mg/m2),C组予以环磷酰胺治疗。统计对比3组临床疗效、不良反应发生率、肾功能指标[血肌酐(serum creatinine,Scr)、尿素氮(blood urea nitrogen,BUN)、24 h尿蛋白定量]、免疫球蛋白[免疫球蛋白(immunoglobulin,Ig)A、IgG、IgM]、血清炎症因子[肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素6(interleukin-6,IL-6)]、TLRs(TLR4、TLR7)水平,并对比A、B两组利妥昔单抗治疗费用。结果A、B组临床缓解率高于C组(P<0.05);治疗2周、4周后,A、B组Scr、BUN、24 h尿蛋白定量低于C组,IgA、IgG、IgM高于C组(P<0.05),治疗2周、4周后,A、B组血清TNFα、IL-6、TLR4、TLR7水平低于C组(P<0.05),A、B组血清TNF-α、IL-6、TLR4、TLR7水平相比,差异无统计学意义(P>0.05);A组不良反应发生率低于B、C组(P<0.05),B、C组不良反应发生率相比,差异无统计学意义(P>0.05);A组利妥昔单抗治疗费用低于B组(P<0.05)。结论极低剂量利妥昔单抗治疗原发性难治性肾病综合征可显著改善患者肾功能、免疫功能,降低TLRs水平,降低不良反应发生率及治疗费用,值得临床推广与应用。
Objective To explore the efficacy of extremely low-dose rituximab for primary re⁃fractory nephrotic syndrome and examine its influence on renal function,immunoglobulins and Toll-like receptors(TLRs).Methods From March 2017 to February 2020,72 patients with primary refractory nephrotic syndrome were selected as research subjects and randomized into 3 groups(n=24 each).Group A received extremely low-dose rituximab(100 mg),group B standard dose rituximab(375 mg/m2)and group C hormone therapy.Clinical efficacy,incidence of adverse reactions and renal function parameters[serum creatinine(Scr),blood urea nitrogen(BUN),24-hour urine protein quantitative],immuno⁃globulins[immunoglobulin(Ig)A,IgG,IgM],serum inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)]and TLRs(TLR4,TLR7)levels were statistically compared among three groups.Treatment expenses of rituximab were compared between groups A and B.Results The clinical remission rate of group A/B was higher than that of group C(P<0.05).After 2/4-week treat⁃ment,the quantitative levels of Scr,BUN and 24 h-urinary protein were lower in group A/B than those in group C.And IgA,IgG and IgM were higher than those in group C(P<0.05).After 2/4-week treat⁃ment,serum levels of TNF-α,IL-6,TLR4 and TLR7 were lower in group A/B than those in group C(P<0.05).No significant difference existed in serum levels of TNF-α,IL-6,TLR4 and TLR7 between groups A and B(P>0.05).The incidence of adverse reactions was lower in group A than that in group B/C(P<0.05)and no significant difference existed in the incidence of adverse reactions between groups B and C(P>0.05).Treatment expense of rituximab was lower in group A than that in group B(P<0.05).Conclusion For primary refractory nephrotic syndrome,extremely low-dose rituximab can sig⁃nificantly improve renal and immune functions,lower the level of Toll-like receptors,reduce the inci⁃dence of adverse reactions and curtail treatment expenses.It is worthy of wider clinical applications.
作者
黄敏
王晓霞
王晓春
王强
Huang Min;Wang Xiao-xia;Wang Xiao-chun;Wang Qiang(Anhui Provincial Corps Hospital of Armed Police,Hefei 230061,China)
出处
《临床肾脏病杂志》
2022年第10期827-833,共7页
Journal Of Clinical Nephrology
