钙调神经蛋白抑制剂联合利妥昔单抗对激素耐药型肾病综合征的疗效

Effect of calmodulin inhibitors combined with rituximab in the treatment of steroid-resistant nephrotic syndrome

目的探究钙调神经蛋白抑制剂(CNI)联合利妥昔单抗治疗激素耐药型肾病综合征的临床疗效。方法选择2019年8月至2022年1月确诊为激素耐药型肾病综合征的患儿40例,随机分为研究组(n=21)与对照组(n=19),对照组接受CNI联合糖皮质激素治疗,研究组在对照组的基础上予利妥昔单抗治疗。比较2组治疗结束6个月的治疗缓解率、生化指标、炎症指标和不良事件发生率。结果治疗6个月研究组治疗缓解率为90.48%,高于对照组的63.16%,差异有统计学意义(P<0.05);治疗6个月2组血清总蛋白、白蛋白水平均高于治疗前(P<0.05),且研究组高于对照组(P<0.05);治疗6个月2组胆固醇、尿素氮及血肌酐水平低于治疗前,且研究组低于对照组(P<0.05);治疗6个月2组超敏C反应蛋白和肿瘤坏死因子-α水平均低于治疗前,且研究组低于对照组(P<0.05);2组不良事件总发生率差异无统计学意义(P>0.05)。结论CNI联合利妥昔单抗治疗激素耐药型肾病综合征,在改善肝肾功能、缓解炎症状态方面效果优于单用CNI,并且不增加不良事件发生率,具有较好的临床推广应用价值。

AIM To investigate the clinical efficacy of calmodulin inhibitor(CNI)combined with rituximab in the treatment of steroid-resistant nephrotic syndrome,and to analyze the impact on the micro-inflammatory state of pediatric patients.METHODS 40 pediatric patients with steroid-resistant nephrotic syndrome who were treated in hospital from August 2019 to January 2022 were selected and divided into the study group treated with CNI in combination with rituximab(n=21)and the control group treated with CNI alone(n=19).The remission rate,biochemical indexes,inflammatory indexes and incidence of adverse events were compared between 2 groups at 6 months after treatment.RESULTS After 6 months of treatment,the treatment response rate in the study group was 90.48%,which was higher than 63.16%in the control group,with a statistically significant difference(P<0.05).The serum total protein and albumin levels increased significantly in both groups,and the serum total protein and albumin levels in the study group were higher than those in the control group(P<0.05).The levels of cholesterol,blood urea nitrogen and serum creatinine in 2 groups were lower than those before treatment,and the levels of the above indicators in the study group were lower than those in the control group after treatment(P<0.05).Both levels of C-reactive protein(hs-CRP)and tumour-necrosis factor-α(TNF-α)in 2 groups decreased,and the levels of hs-CRP and TNF-αin the study group were lower than those in the control group(P<0.05).There was no statistically significant difference in the total incidence of complications between 2 groups(P>0.05).CONCLUSION In the treatment of steroid-resistant nephrotic syndrome,CNI combined with rituximab exhibis a better effect than that of CNI alone in improving hepatic and renal functions and alleviating the inflammatory state,without increasing the frequency of adverse reactions,which has shown good value in clinical promotion and application.