摘要
目的:观察利妥昔单抗(RTX)治疗视神经脊髓炎谱系疾病(NMOSD)的疗效。方法:回顾性观察2008年1月至2018年11月中国人民解放军总医院129例NMOSD患者的治疗,其中55例血清水通道蛋白-4抗体(AQP4-Ab)阳性,74例AQP4-Ab阴性患者。通过90个月的长期随访,评估利妥昔单抗(RTX)、硫唑嘌呤(AZA)及吗替麦考酚酯(MMF)的治疗效果。AQP4-Ab阳性患者中,14例接受低剂量利妥昔单抗RTX治疗,13例接受AZA治疗,8例接受MMF治疗。结果:接受免疫治疗的AQP4-Ab阳性患者中,治疗后的年复发率(ARR)明显低于治疗前的ARR(RTX治疗组ARR从1.00降至0.70,AZA治疗组从0.80降至0.30,MMF治疗组从0.85降至0.35)。同时在AQP4-Ab阴性患者中,治疗后的ARR也低于治疗前(RTX治疗组从0.30降至0.20,AZA治疗组从0.90降至0.50,MMF治疗组从0.90降至0.40)。免疫治疗后的残疾进展(EDSS)有所下降,AQP4-Ab阳性患者的EDSS评分下降(RTX治疗组从4.00分降至2.75分,AZA组从3.50分降至2.50分,MMF组从3.00分降至2.00分)。AQP4-Ab阴性患者的EDSS评分亦有所下降(RTX治疗组从3.00分降至2.50分,AZA组从3.00分降至2.50分,MMF组从3.50分降至2.00分)。RTX,AZA及MMF 3组治疗前、后EDSS及ARR变化比较差异无统计学意义(P>0.05)。Kaplan-Meier生存分析结果显示RTX组患者累积无复发率较AZA组和MMF组高(P<0.05)。RTX治疗的3例患者、AZA治疗的5例患者、MMF治疗的3例患者出现了药物相关副作用,但未出现严重副作用。结论:RTX、AZA及MMF可有效降低AQP4-Ab阳性及阴性NMOSD患者的ARR和EDSS,因低剂量RTX治疗的有效性和安全性,此治疗值得在临床中推广应用。
Objective:To observe the effectiveness of rituximab(RTX)treatment of neuromyelitis optica spectrum disorders,(NMOSD).Methods:A retrospective study was conducted on 129 patients with NMOSD from January 2008 to November 2018 in Chinese PLA General Hospital,including 55 patients with positive aquaporin-4 antibody(AQP4-Ab)and 74 patients with negative AQP4-Ab.The efficacy of rituximab(RTX),azathioprine(AZA)and mycophenolate mofetil(MMF)was evaluated through a longterm follow-up of 90 months.Of AQP4-Ab positive patients,14 patients received low-dose rituximab RTX,13 patients received AZA,and 8 patients received MMF.Results:The median post-treatment annualized relapse rates(ARR)were lower compared to the pretreatment rates in all AQP4-Ab positive patients(from 1.00 to 0.70 in RTX treatment group,from 0.80 to 0.30 in AZA treatment group,and from 0.85 to 0.35 in MMF treatment group).Meanwhile,the ARR also decreased in all AQP4-Ab negative patients(from 0.30 to 0.20 in RTX treament group,from 0.90 to 0.50 in AZA treament group,and from 0.90 to 0.40 in MMF treament group).Disability decreased in expanded disability status scale(EDSS)in all AQP4-Ab positive patients(from 4.00 to 2.75 in RTX treament group,from 3.50 to 2.50 in AZA treament group,and from 3.00 to 2.00 in MMF treament group),as well as disability decreased in EDSS in all AQP4-Ab negative patients(from 3.00 to 2.50 in RTX,from 3.00 to 2.50 in AZA,and from 3.50 to 2.00 in MMF).There wasn't significant statistically difference between the post-treatment and pre-treatment changes of EDSS and ARR with RTX,AZA and MMF the three groups(P>0.05).However,RTX-treated patients were more likely to be relapse-free after long-term follow-up than those who received AZA or MMF therapy according to Kaplan-Meier survival analysis.Moreover,3 patients with RTX treatment,5 patients with AZA treatment,3 patients with MMF treatment,were noted adverse effects.But there was no serious adverse event among these patients.Conclusion:RTX,AZA and MMF can effectively reduce the ARR and EDSS
作者
杨扬
陈利锋
武雷
姚甲瑞
王娜
苏小清
李冬梅
韩丽娜
吴卫平
黄德晖
蒋天裕
王振福
YANG Yang;CHEN Lifeng;WU Lei;YAO Jiarui;WANG Na;SU Xiaoqing;LI Dongmei;HAN Lina;WU Weiping;HUANG Dehui;JIANG Tianyu;WANG Zhenfu(Department of Neurology,the Second Medical Center,National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China)
出处
《中国免疫学杂志》
CAS
CSCD
北大核心
2023年第5期1029-1034,共6页
Chinese Journal of Immunology
基金
全军保健专项科研课题项目(18BJZ34)。
