利妥昔单抗在儿童原发性肾病综合征的应用进展

Application of Rituximab in Children with Primary Nephrotic Syndrome

利妥昔单抗(Rituximab,RTX)是一种人鼠嵌合型抗CD20单克隆抗体,能与B淋巴细胞表面CD20分子高亲和力结合而触发凋亡信号,导致被结合的B淋巴细胞清除,现已被用于多种自身免疫性疾病的治疗。原发性肾病综合征(Idiopathic nephritic syndrome,INS)是儿科常见肾脏疾病,属自身免疫性疾病。目前临床对INS患儿的治疗以激素为主,必要时辅以免疫抑制剂,但其不良反应和复发率高。近几年有文献报道RTX逐渐应用于治疗成人和儿童的难治性肾病综合症,尤其是儿童激素依赖或频复发型肾病综合征,成功延长了此病的缓解期。但近几年RTX应用于INS主要基于对散在病例的观察性研究,RTX的疗效和安全性需要大样本、随机、对照及前瞻性试验来证实。因此,我们将总结前面的研究,并为以后更好地研究和治疗INS提供方向。

Rituximab( RTX) is a human chimeric anti-CD20 monoclonal antibody that binds to a high affinity for CD20 molecules on the surface of B lymphocytes to trigger an apoptotic signal,resulting in binding of B lymphocytes cleared,has been used for the treatment of a variety of autoimmune disorder. Idiopathic nephritic syndrome( INS) is a common pediatric kidney disease,and an autoimmune disease. At present,the main clinical treatment of INS in children is hormone-based,supplemented by immunosuppressive agents if necessary,but the adverse reactions and recurrence rate are high. In recent years,many literatures reported anti-CD20 therapy has been used for the treatment of the nephritic syndrome in adults and children,especially in children with steroid dependent or frequency complex onset nephritic syndrome,successful rituximab therapy induces prolonged remission and without substantially increasing the risk of infections and other serious adverse events. However,RTX has been reported in the treatment of adult and children with refractory nephrotic syndrome,especially in children with hormone-dependent or recurrent nephrotic syndrome,successfully prolonged the remission of the disease. However,in recent years,RTX has been applied to INS mainly based on observational studies of scattered cases. The efficacy and safety of RTX require large sample,randomized,controlled and prospective trials to confirm. Therefore,we will summarize the previous research,and provide direction for future research and better treatment of INS.