小剂量利妥昔单抗治疗难治性肾病综合征2例并文献复习

Two cases report of low dose rituximab therapy for refractory nephrotic syndrome and literature review

目的通过2例典型病例结合文献复习探讨利妥昔单抗(RTX)治疗难治性肾病综合征(RNS)的作用机制、疗效及存在的问题。方法对华中科技大学同济医学院附属同济医院肾内科收治的2例RNS患者的临床资料及采用小剂量RTX治疗后的疗效进行回顾性分析,并对相关文献进行复习。结果 1例患者经肾活检诊断为II期膜性肾病,在经过糖皮质激素及常用免疫抑制剂(环磷酰胺、他克莫司、霉酚酸酯)治疗无明显好转的情况下,给予RTX100 mg/月治疗3个月后患者白蛋白明显升高,血肌酐下降,估算肾小球滤过率增加,尿蛋白显著减少,达到部分缓解。另1例患者糖皮质激素联合(霉酚酸酯、环磷酰胺、他克莫司)治疗可以缓解,但是减量过程中频繁复发,给予单次RTX100 mg治疗后患者白蛋白升至正常,尿蛋白转阴,达到完全缓解。2例患者治疗过程中没有出现明显不良反应。结论小剂量RTX治疗RNS是安全有效的。

Objective To explore the mechanism,curative effect and existing problems of rituximab therapyforpatientswith refractory nephrotic syndrome through analysis of 2 typical cases and literature review.Methods The clinical characteristics and effects of low dose rituximab for two patients with refractory nephrotic syndrome were retrospectively analyzed and the related literatures were reviewed.Results Case 1 was diagnosed as stage Ⅱ membranous nephropathy by renal biopsy.Glucocorticoids and commonly used immunosuppressants（cyclophosphamide,tacrolimus,mycophenolatemofetil）had poor efficacy and the disease could not be alleviated.After administration of rituximab（100 mg）permonth for 3 months,serum albumin was significantly elevated,serum creatinine was decreased,eGFR was increased,urinary protein was significantly reduced,and patient achieved partial remission.Case 2 given glucocorticoid in combination with mycophenolatemofetil,cyclophosphamide andtacrolimus could be relieved,but frequent relapses occurred during drugs reduction.Complete remission could be achieved after a single rituximab（100mg）treatment.The albumin level increased to the normal level,and urinary protein turned negative.There was no obvious adverse reaction during the treatment.Conclusions Low dose rituximab is a safe and effective treatment for refractory nephrotic syndrome.