利妥昔单抗治疗23例狼疮肾炎的疗效与安全性

Efficacy and safety of half-dose rituximab in the treatment of 23 cases with lupus nephritis

分析利妥昔单抗治疗23例狼疮肾炎的疗效与安全性, 探索半剂量利妥昔单抗治疗狼疮肾炎的前景。选2013年5月至2021年12月在解放军总医院第一医学中心风湿免疫科住院的23例狼疮肾炎患者, 18例患者于第1天和第14天给予利妥昔单抗375 mg/m^(2), 5例患者于第1天和第14天给予利妥昔单抗500 mg, 6个月后依病情需要按需使用。第1天和第14天同时给予80~120 mg甲泼尼龙, 后以1 mg/kg甲泼尼龙维持4周, 依病情酌情减量至维持量或停用。记录利妥昔单抗治疗后B淋巴细胞水平、肾功能、24 h尿蛋白定量、系统性红斑狼疮疾病活动指数2000评分(SLEDAI-2K)。分析疗效及不良反应。结果显示, 基线期11例患者存在肾功能不全, 利妥昔单抗诱导治疗后12个月9例患者肌酐水平恢复正常[(66.3±10.1) μmol/L 比 (162.7±58.6) μmol/L];12例基线期肾功能正常患者在治疗过程中未出现肾功能恶化。利妥昔单抗诱导治疗12个月后20例患者24 h尿蛋白定量显著降低[4.00(2.00, 6.80)g 比 0.10(0.08, 0.40) g]。利妥昔单抗治疗后SLEDAI-2K明显降低[22(18, 26)比 3(0, 6)], B淋巴细胞水平在3个月时达到0.00(0.00, 0.01)%。23例患者利妥昔单抗治疗6个月时13例患者达到完全缓解, 7例患者部分缓解。5例患者出现不良反应, 输液反应1例, 口周疱疹伴肺部感染1例, IgG减低3例。提示本研究采用的利妥昔单抗治疗方案是狼疮肾炎的有效治疗策略。

The study aimed to analyze the efficacy and safety of rituximab in the treatment of 23 cases of lupus nephritis and explore the prospect of half-dose rituximab in lupus nephritis treatment.Twenty-three patients with lupus nephritis hospitalized in the Department of Rheumatology and Immunology at the First Medical Center of the PLA General Hospital from May 2013 to December 2021 were selected.Eighteen patients received rituximab 375 mg/m^(2) on the first and 14th days,5 patients received 500 mg of rituximab on the first and 14th days,and rituximab was used as needed 6 months later.Methylprednisolone(80-120 mg)was given together with rituximab.Afterward,1 mg/kg prednisone was used for 4 weeks,which was progressively tapered to maintenance doses or discontinued.B lymphocyte level,renal function,24-h urine protein level,and systemic lupus erythematosus(SLE)disease activity index 2000(SLEDAI2K)score before and after treatment were recorded.The efficacy and adverse reactions were analyzed.The results showed that 11 patients suffered from renal insufficiency[creatinine(162.7±58.6)μmol/L]at baseline,while the creatinine level of 9 patients returned to normal 12 months after the treatment[(66.3±10.1)μmol/L].Normal renal function of the other 12 patients was maintained during treatment.After 12 months,the 24-h urine protein level decreased from 4.00(2.00,6.80)g in the baseline period to 0.10(0.08,0.40)g.SLEDAI2K score decreased from 22(18,26)in the baseline period to 3(0,6)12 months after the treatment.The B lymphocyte level reached 0.00(0.00,0.01)%at 3 months.Of 23 patients,13 patients achieved complete remission,and 7 patients achieved partial remission after 6 months of rituximab treatment.Five patients experienced adverse reactions related to rituximab,including 1 case of transfusion reaction,1 case of perioral herpes with pulmonary infection,and 3 cases of decreased IgG levels.Therefore,rituximab regimen used in this study can be an effective treatment strategy for lupus nephritis.