【摘要】 目的观察低剂量利妥昔单抗（rituximab, RTX）预防成人激素依赖微小病变肾病综合征（steroid-dependent minimal change nephritic syndrome, SDMCNS）复发的疗效。方法回顾性分析2018年11月至2019年12月我院收治且随访时间大于18个月的接受低剂量RTX治疗的8例SDMCNS患者临床检验资料。结果 （1）8例患者应用RTX时中位年龄28.5（18～53）岁,在中位24.5（18～28）个月随访中分别有5例、3例间歇使用RTX 0.375 g/m² 2剂、3剂。（2）所有患者一年内无复发,其中4例监测CD19⁺B细胞数增加至绝对值大于6个/μL时重复使用RTX 0.375 g/m² 的SDMCNS患者,至随访期末复发。（3）对比RTX治疗前后一年临床资料发现,8例患者经RTX治疗后激素应用量减少,随访期末维持7.5（0～20）mg/d,其中2例患者停用激素,且复发次数、住院次数及并发症均显著减少。（4）8例患者应用RTX后,除1例患者出现皮疹及皮肤瘙痒外,其余患者无明显不良反应。结论低剂量RTX治疗成人SDMCNS,在监测CD19⁺B细胞数基础上重复使用RTX,可减少复发同时减少经济支出,且不良反应少。更多还原

【Abstract】 Objective To explore the therapeutic efficacy of low-dose rituximab(RTX)for a relapse of steroid-dependent minimal-change nephrotic syndrome(SDMCNS)in adults.Methods From November 2018 to December 2019,8 male SDMCNS patients were retrospectively analyzed.They received low-dose RTX treatment and were followed up for over 18 months.Results The median age was 28.5(18-53)years and the median follow-up period 24.5(18-28)months.And 5 and 3 cases received 2 and 3 intermittent doses of RTX 0.375 g/m~2 respectively.None of them had a relapse within 1 year.RTX 0.375 g/m~2 was repeated for 4 cases when CD19~+ B-cell count dropped to 6.No relapse occurred at the end of follow-up period.A comparison of clinical data at 1 year before and after RTX dosing, hormone dose declined.At the end of follow-up period, the maintenance dose was 7.5(0-20)mg/d.Two discontinued horome and frequency of relapse/hospitalization and incidence of complications decreased markedly.Except for skin rash and pruritus in one case, the remainders had no obvious adverse effects.Conclusion For SDMCNS in adults, using low-dose RTX may be repeated based upon monitoring CD19~+ B-cell count.Such a regimen may lower the frequency of relapse and reduce economic expenditures with fewer side effects.更多还原