利妥昔单抗治疗冷球蛋白血症相关膜增生性肾小球肾炎的疗效

Efficacy of rituximab in treatment of cryoglobulinaemic membranoproliferative glomerulonephritis

目的:观察利妥昔单抗(RTX)治疗冷球蛋白血症相关膜增生肾小球肾炎(MPGN)患者的疗效及不良反应。方法:回顾性分析8例经肾活检病理诊断为冷球蛋白血症相关MPGN患者的资料,接受RTX治疗并随访≥12月;RTX按单次375 mg/m^(2)静脉输注。结果:4例为乙型肝炎病毒(HBV)感染相关,4例原发病因不明确。所有患者均联合激素治疗,2例联合他克莫司治疗,4例HBV感染者予恩替卡韦抗病毒治疗。中位随访时间35(12~40)月,末次随访4例完全缓解,2例部分缓解,2例无效。RTX治疗中未观察到急性或慢性严重不良反应。结论:RTX联合激素可成为冷球蛋白血症相关MPGN的治疗选择,其疗效及安全性较好,值得进一步深入研究。

Objective:To observe the efficacy and side effects of rituximab(RTX) in the treatment of cryoglobulinaemic membranoproliferative glomerulonephritis(MPGN). Methodology:Eight patients with biopsy proven cryoglobulinaemic MPGN were enrolled in this study. RTX was given intravenously at 375 mg/m2. Results:Four patients were associated with HBV infection. All patients were treated with glucocorticosteroid therapy, combined with tacrolimus in 2 cases. Entecavir were prescribed to 4 patients with HBV infection. With a median follow-up of 35(12~40) months, 4 cases achieved complete remission, 2 cases achieved partial remission and 2 cases failed to respond. No acute or chronic serious adverse reactions were observed during RTX treatment. Conclusion:RTX combined with glucocorticosteroid can be an effective and safe selection in patients with cryoglobulinaemic MPGN,which may be worthy of further study.