【摘要】 目的观察B细胞监测下减量利妥昔单抗方案治疗视神经脊髓炎谱系病(NMOSD)患者的疗效及安全性。方法收集2016年12月-2019年6月苏州大学附属第一医院神经内科规律随访的35例NMOSD患者临床资料,分为B细胞监测下减量利妥昔单抗组、硫唑嘌呤组及环磷酰胺组,比较治疗前后扩展残疾状态量表评分差值、未复发的可能性、药物不良反应等指标。结果 (1) RTX组比AZA组治疗前后EDSS评分下降水平明显,具有统计学意义(P <0.05);(2) RTX组和CTX组的复发风险明显低于AZA组,差异有统计学意义(Log-rankχ2=9.147,P=0.01);(3) RTX组总不良事件发生比例较CTX组少,RTX组激素停药率高于AZA组和CTX组(P <0.05),差异具有统计学意义;(4) RTX组平均用药间隔时间7.00(6.0,10.0) m。结论 B细胞监测下减量利妥昔单抗方案治疗NMOSD总体安全、有效,可延长用药间隔,减少患者的用药费用支出。更多还原

【Abstract】 Objective To investigate the efficacy and safety of a reduced-dosage rituximab( RTX) treatment regimen for neuromyelitis optica spectrum disorders( NMOSD) under B cell monitoring. Method Clinical data from 35 patients with NMOSD who were regularly followed up in the Department of Neurology of the First Affiliated Hospital of Soochow University from December 2016 to June 2019 were collected. They were divided into rituximab reduction group under B cell monitoring,azathioprine group and cyclophosphamide group. Differences in the indexes including the Expanded Disability Status Scale( EDSS) score,possibility of no recurrence,and adverse drug reactions were used to evaluate the efficacy and safety of the three treatment regimens. Results( 1) The EDSS score of the RTX group was significantly lower than that of the AZA group before and after treatment( P < 0. 05).( 2) The relapse risk of the RTX and CTX groups was significantly lower than that of the AZA group( Log-rank χ2= 9. 147,P = 0. 01).( 3) The proportion of total adverse events in the RTX group was less than that in the CTX group. The glucocorticoids withdrawal rate in the RTX group was higher than that of the AZA group and the CTX group( P < 0. 05),and the difference was statistically significant.( 4) The mean interval of treatment in RTX group was7. 00( 6. 0,10. 0) months. Conclusion The reduced-dose rituximab regimen under B cell monitoring is generally safe and effective in the treatment of NMOSD,which can prolong the medication interval and reduce the medication expenses of patients.更多还原