重复利妥昔单抗在儿童肾病综合征中的疗效评估

Efficiency of repeated rituximab in treating children with nephrotic syndrome

目的分析利妥昔单抗(RTX)重复使用治疗儿童频复发(FRNS)或激素依赖型肾病综合征(SDNS)维持缓解的有效性和安全性。方法选取2020年3月至2022年1月在安徽省儿童医院诊断FRNS或SDNS并接受重复RTX治疗且随访≥12月的30例儿童。给予RTX每次375 mg/m2,监测CD19恢复后予RTX重复治疗2~3疗程。回顾性分析RTX治疗后半年、1年内尿蛋白持续缓解率,RTX治疗前后的复发次数、糖皮质激素累积剂量、身体质量指数、身高变化及RTX治疗不良反应。结果RTX治疗后半年及1年尿蛋白持续缓解率分别为90%、83.33%。与治疗前相比,RTX治疗后半年、1年内复发次数、激素使用剂量明显下降;RTX治疗1年后患儿的身体质量指数下降,身高回升,差异均有统计学意义(P<0.05)。使用RTX时及后期随访中未见严重不良反应。结论重复RTX治疗能够延长儿童FRNS和SDNS持续缓解时间,且安全性良好。

Objective To analyze the efficacy and safety of rituximab(RTX)readministration to maintain remission in children with frequently relapsing nephrotic syndrome(FRNS)or steroid-dependent nephrotic syndrome(SDNS).Methods Thirty children who diagnosed with FRNS or SDNS in Anhui Provincial Children's Hospital from March 2020 to January 2022 and received repeated RTX treatment with follow-up≥12 months were enrolled.RTX(375 mg/m2)was given,and RTX was repeated for 2~3 courses after monitoring CD19 recovery.The rate of sustained remission of proteinuria within six months or 1 year after RTX treatment,the number of relapses,the cumulative dose of glucocorticoids,the body mass index,the height changes before and after RTX treatment,and adverse effects were retrospectively analyzed.Re⁃sults The sustained remission rate of proteinuria within six months and 1 year after RTX treatment was 90%and 83.33%,respectively.Compared to before treatment,the number of relapses and glucocorticoid doses within six months and 1 year after RTX treatment were significantly reduced.The body mass index of the children decreased and their height increased after 1 year of RTX treatment(all P<0.05).There were no serious adverse effects while using RTX or during later follow-up.Conclusion Repeated RTX treatment can prolong the duration of remission of FRNS and SDNS in children,and is safe.