利妥昔单抗应用于原发性膜性肾病的研究进展

Advance research of rituximab in idiopathic membranous nephropathy

利妥昔单抗是针对B细胞表面抗原CD20的单克隆抗体,可选择性杀伤B细胞,减少循环抗体的产生及机体免疫反应,进而达到治疗原发性膜性肾病(IMN)的目的。目前研究发现利妥昔单抗治疗IMN有较好的疗效及安全性,初始治疗方案主要有三种,即4剂疗法、2剂疗法与单剂疗法,维持治疗方案有以B细胞为指标的治疗及固定时间间隔后重复治疗。利妥昔单抗治疗IMN期间应监测B细胞数量、CD4^+ T细胞与CD8^+ T细胞比值、抗磷脂酶A2受体抗体滴度等,人抗嵌合体抗体对再治疗的影响尚不完全明确。两项与利妥昔单抗治疗IMN相关的多中心研究正在进行中,将为IMN的治疗提供更为科学的依据。

Rituximab, a monoclonal antibody targeting CD20, can selectively kill B cells to reduce circulating antibodies and immune response and then to achieve the purpose of the treatment of idiopathic membranous nephropathy （IMN）. The present study found that rituximab had good efficacy and safety for the treatment of IMN. There are three main types of initial treatment, namely four- agent therapy, two- agent therapy and single- agent therapy. We can make the number of B cells as the index of therapy for the maintenance treatment or repeat the treatment of rutuximab in a fixed time interval. During the period of rituximab in the treatment of IMN, we should monitor the B cell number, CD4＋/CD8 ~ T cell ratio, anti- phospholipase A2 receptor antibody titer, and so on. Effect of human anti- chimeric antibodies on the retreatment is still not completely clear. Two muhicenter studies about rituximab in treating of IMN are underway to provide a more scientific basis for the therapy of IMN.