利妥昔单抗治疗患儿激素依赖型肾病的初步研究

Rituximab for steroid-dependent nephrotic syndrome in children

目的近年来生物制剂广泛应用于多种疾病的治疗,其中利妥昔单抗(rituximab,RTX,商品名美罗华)是抗CD20的单克隆抗体。随着对B淋巴细胞作用机制的深入了解,RTX已用于难治性肾病的治疗并取得良好的疗效。文中探讨RTX对患儿激素依赖型肾病的治疗效果。方法患儿体重25kg,按体表面积375mg/M2计算,将RTX 365mg稀释于10%葡萄糖液400ml中静脉缓慢滴注,起始滴注速度为50mg/h,1 h后逐渐增加剂量,每0.5h增加50mg,用药前0.5h静脉推注异丙嗪12.5 mg,用药前5 min静脉推注地塞米松2.5 mg。1周后再次应用RTX 300 mg稀释于10%葡萄糖液400 ml中缓慢静脉滴注。治疗前后均检测外周血CD20+细胞计数和比例。结果第1次用药前采血查CD20+细胞计数为288个/μl,比例为1.1%。用药后第5天复查CD20+计数为16个/μl,比例为0.3%;第2次用药后第3天再次复查CD20+计数为1个/μl,比例为0.01%。从第1次使用RTX后尿蛋白即转为阴性,未再复发。结论 RTX对外周血中高CD20+的激素依赖型肾病有很好的临床疗效,无明显不良反应。

Objective Biological agents have been widely applied to the treatment of various diseases,among which is rituximab(RTX),an anti-CD20 monoclonal antibody.With the deeper insight into the action mechanisms of the B lymphocyte,RTX has been successfully used in the management of refractory kidney diseases.This study aimed to investigate the effect of RTX on steroid-dependent nephrotic syndrome in children.Methods The patient was a 7-year-old boy weighing 25 kg,who was treated with RTX 375 mg/m2 body surface by intravenous drip of 365 mg TX diluted in 400 ml of 10% glucose at the rate of 50 mg/h.An hour later,the dose was increased by 50 mg every half an hour.Half an hour before RTX administration,12.5 mg of promethazine was injected intravenously,and 5 minutes before that 2.5 mg of dexamethasone.A week later,slow intravenous drip of 300 mg of RTX was given again,diluted in the same amount and concentration of glucose.The number and proportion of the CD20-positive cells were measured before and after RTX administration.Results The count and proportion of the CD20-positive cells were 288/μl and 1.1% before the treatment,reduced to 16/μl and 0.3% five days after the first administration,and again reduced to 1/μl and 0.01% three days after the second administration.Proteinuria was not observed during the three months after the first RTX treatment.Conclusion RTX is efficacious for steroid-dependent nephrotic syndrome in children with high CD20 cells+,and it has no obvious adverse effects.