利妥昔单抗联合免疫抑制剂对特发性膜性肾病的临床疗效

Clinical effect of rituximab combined with in treatment of idiopathic membranous nephropathy

目的探讨利妥昔单抗联合免疫抑制剂对特发性膜性肾病(IMN)患者的临床疗效。方法选取2018年8月至2020年8月的129例IMN患者作为研究对象,随机分为3组,每组各43例。对照A组予以环磷酰胺治疗,对照B组予以利妥昔单抗治疗,观察组予以利妥昔单抗联合环磷酰胺治疗。对比3组疾病缓解率、肾病相关指标、T淋巴细胞亚群、尿中攻膜复合物(C5b-9)、免疫球蛋白G4(IgG4)、复发率及感染并发症发生率。结果观察组疾病缓解率高于对照A、B组(P<0.05);治疗后观察组24h尿蛋白定量、尿C5b-9、Ig G4低于对照A、B组,血清白蛋白高于对照A、B组(P<0.05);治疗后观察组CD4^(+)、CD4^(+)/CD8^(+)低于对照A、B组,CD8^(+)高于对照A、B组;观察组12个月复发率低于对照A、B组(P<0.05);3组感染并发症发生率比较,差异无统计学意义(P>0.05)。结论利妥昔单抗联合免疫抑制剂可有效缓解IMN病情,并改善肾功能、免疫功能,且安全可靠。

AIM To investigate the clinical efficacy of rituximab in combination with immunosuppressants in patients with idiopathic membranous nephropathy(IMN).METHODS A total of 129 patients with IMN from August 2018 to August 2020 were selected as study subjects and randomly divided into 3 groups,with 43 cases in each group.Control group A was treated with cyclophosphamide,control group B was treated with rituximab,and observation group was treated with rituximab combined with cyclophosphamide.The disease remission rate,nephropathy-related indexes,T lymphocyte subpopulation,urinary tapping membrane complex(C5b-9),immunoglobulin G4(IgG4),relapse rate and the incidence of infection complications were compared among 3 groups.RESULTS The disease remission rate in the observation group was higher than that in control groups A and B(P<0.05);the 24 h urine protein quantification,urine C5b-9 and IgG4 in the observation group were lower than those in control groups A and B after treatment,and serum albumin in the observation group was higher than that in control groups A and B(P<0.05);CD4^(+),CD4^(+)/CD8^(+)were lower in the observation group after treatment than in control groups A and B groups,and CD8^(+)was higher than control A and B groups;the 12-month recurrence rate was lower in the observation group than control A and B groups(P<0.05);the differences were not statistically significant when comparing infection complications in 3 groups(P>0.05).CONCLUSION Rituximab combined with immunosuppressants can effectively alleviate IMN disease and improve renal and immune function,and is safe and reliable.