利妥昔单抗治疗小儿神经系统自身免疫病的疗效分析

Analysis of curative effect of Rituximab on autoimmune diseases of nervous system in children

目的探讨神经系统自身免疫病患儿应用利妥昔单抗(RTX)疗效及安全性。方法选取云南省昆明市儿童医院收治的难治复发性神经系统自身免疫病40例,比较RTX治疗前后的残疾状态量表评分、年复发率(ARR)、血常规及免疫球蛋白的差异,同时监测B淋巴细胞亚群的变化。结果患者RTX治疗前后锥体系功能、膀胱直肠功能、视觉功能及脑干功能比较,差异有统计学意义(P <0.05);治疗后ARR较治疗前降低(P<0.05);患者RTX治疗前后IgG、IgM及IgA比较,差异有统计学意义(P<0.05);治疗后CD19^+较治疗前降低(P<0.05),不良反应发生率为35%。结论 RTX可改善难治复发性神经系统自身免疫病患儿的临床症状,偶有发热、寒战等不良反应,可能是难治复发性神经系统自身免疫病的有效药物。

Objective To investigate and analyze the efficacy and safety of Rituximab in children with neurological autoimmune diseases.Methods Forty cases of refractory and recurrent autoimmune diseases of nervous system admitted to our hospital were selected.Differences in Disability Status Scale(EDSS)score,annual recurrence rate(ARR),blood routine indexes(platelets,WBC,Hct and Hb),and immunoglobins before and after Rituximab treatment were compared;changes in B lymphocyte subsets were monitored.Results The differences in pyramidal function,bladder and rectum function,visual function and brainstem function before and after Rituximab treatment were statistically significant(P<0.05).The ARR decreased significantly after treatment(P<0.05).There were significant differences in IgG,IgM,and IgA before and after treatment(P<0.05).The number of CD19^+lymphocytes after treatment was significantly smaller than that before treatment(P<0.05).The incidence of adverse reactions was 35%.Conclusions Rituximab can improve the long-term clinical symptoms in patients with recurrent and refractory autoimmune diseases in the nervous system,with occasional adverse reactions such as fever and chills.It may be an effective drug to treat autoimmune diseases of nervous system that are refractory and recurrent.