利妥昔单抗与环磷酰胺治疗儿童激素依赖型或耐药型肾病综合征对肾功能、血脂及凝血功能的影响

Effects of Rituximab and Cyclophosphamide on Renal Function, Blood Lipids and Coagulation Function in the Treatment of Children with Hormone-dependent or Drug-resistant Nephrotic Syndrome

关键词:  利妥昔单抗  激素依赖型综合征  耐药型肾病综合征  肾病综合征

Key words:  rituximab  hormone dependent syndrome  drug-resistant nephrotic syndrome  nephrotic syndrome

摘要:

目的 探讨利妥昔单抗与环磷酰胺治疗儿童激素依赖型或耐药型肾病综合征对肾功能、血脂及凝血功能的影响。方法 选取2017年1月-2020年2月诊治的68例原发性肾病综合征患儿(激素依赖型48例,激素耐药型20例)作为研究对象,按照随机数字表法分为对照组(予以糖皮质激素联合环磷酰胺)与观察组(予以糖皮质激素联合利妥昔单抗),各34例。且评估2组血浆纤维蛋白原(fibrinogen,Fib)、D二聚体、总胆固醇(total cholesterol,TC)、甘油三酯(triacylglycerol,TG)、低密度脂蛋白(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白(high-density lipoprotein cholesterol,HDL-C)、尿蛋白定量、尿素氮(urinary nitrogen,BUN)、血肌酐(serum creatinine,Scr)、β2微球蛋白(β2-MC)及复发率、不良反应情况。结果 治疗前,2组Fib、D二聚体、TC、TG、LDL-C、HDL-C、尿蛋白定量、BUN、Scr、β2-MC比较差异无统计学意义;治疗1,3个月后,观察组的Fib、D二聚体、TC、TG、LDL-C、尿蛋白定量、BUN、Scr、β2-MC低于对照组,而HDL-C高于对照组(P<0.05)。观察组仅出现1例复发,其发生率低于对照组(P<0.05)。观察组仅出现2例发热,其总发生率低于对照组(P<0.05)。结论 利妥昔单抗治疗激素依赖型与耐药型肾病综合征疗效显著,既能改善肾功能,又能降低血脂水平。

Abstract:

OBJECTIVE To explore the effects of rituximab and cyclophosphamide on renal function, blood lipids and coagulation function in the treatment of children with hormone-dependent or drug-resistant nephrotic syndrome. METHODS A total of 68 children with primary nephrotic syndrome(48 cases of hormone-dependent and 20 cases of hormone-resistant) who were diagnosed and treated from January 2017 to February 2020 were selected as the research objects, and were divided into the control group according to the random number table method(glucocorticoid combined with cyclophosphamide) and observation group(glucocorticoid combined with rituximab), 34 cases in each group. And to evaluate the fibrinogen(Fib), D dimer, total cholesterol(TC), triacylglycerol(TG), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol (HDL-C), urine protein quantification, urinary nitrogen(BUN), serum creatinine(Scr), β2 microglobulin(β2-MC), recurrence rate, and adverse reactions in two groups. RESULTS Before treatment, the two groups of Fib, D dimer, TC, TG, LDL-C, HDL-C, urine protein quantification, BUN, Scr, β2-MC were compared, and there was no statistical difference. After 1 and 3 months of treatment, Fib, D dimer, TC, TG, LDL-C, urine protein quantification, BUN, Scr, and β2-MC in the observation group were lower than those in the control group, HDL-C was higher than the control group(P<0.05). There was only 1 case of recurrence in the observation group, and its incidence was lower than that of the control group(P<0.05). There were only 2 cases of fever in the observation group, and the total incidence was lower than that in the control group(P<0.05).CONCLUSION Rituximab is effective in the treatment of hormone-dependent and drug-resistant nephrotic syndrome, which can not only improve renal function, but also reduce blood lipid level.