目的 探讨利妥昔单抗治疗老年患者特发性膜性肾病的临床效果。方法 选取2020-01至2023-12晋城市人民医院收治的老年特发性膜性肾病患者60例,采用随机数字表法分为研究组和对照组,每组30例,对照组采用小剂量激素联合他克莫司治疗,研究组采用低剂量利妥昔单抗治疗。观察两组治疗前及治疗3个月、6个月后,24 h 尿蛋白定量、血清白蛋白、血肌酐、血尿酸、总胆固醇,估算肾小球滤过率、血清抗磷脂酶 A2 受体抗体滴度水平变化。结果 两组治疗前一般情况、血生化等方面比较,差异均无统计学意义。研究组2例退出随访,最终入组28例。治疗3个月,研究组尿蛋白定量1232.0（400.0,3040.0）mg,缓解率53.57%,对照组尿蛋白定量2204.0（1400.0,5725.0）mg,缓解率46.66%,研究组早期尿蛋白降低水平及缓解率优于对照组,差异有统计学意义（P<0.05）。治疗6个月后,研究组尿蛋白定量为2464.0（1472.0,3455.0）mg,缓解率71.42%,而对照组尿蛋白定量为1145.0（315.0,3959.0）mg,缓解率66.66%,研究组及对照组均有长期持续缓解的作用。结论 采用低剂量利妥昔单抗治疗老年特发性膜性肾病具有更早期的缓解率,且在获得等效长期缓解率的情况下,低剂量利妥昔单抗安全性更高,疗效更佳。
Abstract
Objective To explore the clinical effect of rituximab in the treatment of idiopathic membranous nephropathy in elderly patients. Methods 60 patients with idiopathic membranous nephropathy admitted to Jincheng People's Hospital from 2020-01 to 2023-12 were selected and divided into research group and control group by randomized numerical table method, with 30 cases in each group; the control group was treated with low-dose hormone combined with tacrolimus, and the research group was treated with low-dose rituximab. To observe the changes of 24 h urine protein quantification, serum albumin, blood creatinine, blood uric acid, total cholesterol, estimated glomerular filtration rate, serum antiphospholipase A2 receptor antibody titer level before treatment and at 3 and 6 months of treatment in both groups. Results Comparison of general condition and blood biochemistry before treatment in both groups showed no statistically significant difference. Two cases in the study group were withdrawn from the follow-up, and 28 cases were finally enrolled. After 3 months of treatment, urine protein quantification of the study group was 1232.0 (400.0, 3040.0) mg, with a remission rate of 53.57%, and urine protein quantification of the control group was 2204.0 (1400.0, 5725.0) mg, with a remission rate of 46.66%, and the level of early reduction of urinary protein and remission rate of the study group were better than that of the control group, with statistically significant differences (P<0.05).At 6 months of treatment, the quantitative urine protein of the study group was 2464.0 (1472.0, 3455.0) mg, with a remission rate of 71.42%, while the quantitative urine protein of the control group was 1145.0 (315.0, 3959.0) mg, with a remission rate of 66.66%, and there was a long-term and sustained remission of both the study and control groups. Conclusions Treatment of elderly idiopathic membranous nephropathy with low-dose rituximab has earlier remission rate and is safer and more efficacious when equivocal long-term remission rate is obtained.
关键词
老年 /
特发性膜性肾病 /
低剂量 /
利妥昔单抗 /
他克莫司
Key words
elderly /
idiopathic membranous nephropathy /
low-dose /
rituximab /
tacrolimus
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