利妥昔单抗在儿童硬化性肾炎中的应用

摘要

Objective To study the application and significance of rituximab in children with sclerosing glomerulonephritis.Methods A four-year-old boy with sclerosing glomerulonephritis was chosen.CD19, CD20, CD3 , CD4, CD8, immunoglobulin, complement, blood routine tests, liver function, and renal function were examined before application of rituximab.Promethazine ( 0.5 - 1 mg/kg ) was administered intravenously in bolus half an hour before application of rituximab, dexamethasone (0.1 - 0.3 mg/kg) was administered intravenously in bolus 5 -10 minutes before application of rituximab.Rituximab ( 375 mg/m2) was diluted in 300 ml glucose solution and administered intravenously.One month later the patient was treated with the same protocol.Results The eyelid edema and limb swelling of the patient declined two weeks after adiministration of rituximab, the urine protein declined ( urine protein 2+, 24-hour urine protein 0.68 g/L, urine NAG enzyme 17.2 U/g·cr), the albumin increased, there was no change in white blood cell count, hepatic function and renal function; The eyelid edema and limb swelling disappeared after the second intravenous administration; 3 months later, urine protein decreased significantly ( urine protein 1+ , 24-hour urinary protein 0.32 g/L, urine NAG enzyme 13.4 U/g·cr), serum albumin ( 35.2 g/L) cholesterol ( 5.4 mmol/L ) returned to normal, Th cells reduced ( CD3+ CD4+ 25.0％ ), B lymphocytes reduced ( CD3+ CD8+ 36.0％, Th : Ts 0.69; CD19+ 6 个/U; CD19+ Gate 0.3％, CD20+ 6 个/μl, CD20+ Gate 0.3％ ).No any side effect was found.Conclusions After the intervention of rituximab, the symptoms and signs of the patient relieved, B cell and Th cell declined, which showed that rituximab have made an effect on both cell-mediated immunity and humoral immunity through the treatment to B cell.It opens a new way to manage patients with sclerosing glomerulonephritis.%目的 研究利妥昔单抗在儿童硬化性肾炎中的临床应用及意义.方法 1例硬化性肾炎患儿,使用利妥昔单抗前检查CD19、CD20、CD3、CD4、CD8、免疫球蛋白定量、补体、血常规、肝肾功能等指标,用药前半小时静脉推注非那根0.5～1 mg/kg,用药前5～10 min静脉推注地塞米松0.1～0.3 mg/kg;利妥昔单抗375 mg/㎡稀释于5%葡萄糖溶液300 ml,静脉滴注.1个月后第2次应用,共2次.结果 利妥昔单抗第1次静脉滴注后2周眼睑浮肿与双下肢浮肿减轻,1个月检查尿蛋白减少[尿蛋白2+,24 h尿蛋白定量0.68 g/L,尿NAG酶17.2 U/(g·cr)],血清白蛋白增加,血白细胞与肝肾功能无影响;第2次静脉滴注后1周眼睑浮肿与双下肢浮肿消失;3个月复查尿蛋白明显减少[尿蛋白1+,24 h尿蛋白定量0.32 g/L,尿NAG酶13.4 U/(g·cr)],血清白蛋白(35.2 g/L)、胆固醇(5.4 mmol/L)均恢复到正常,Th减少(CD4+CD3+25.0%),B淋巴细胞减少(CD8+CD3+36.0%,Th:Ts 0.69;CD19+6个/μl,CD19+Gate 0.3%,CD20+6个/μl,CD20+Gate 0.3%),血白细胞与肝肾功能无影响.无任何不良反应.结论 硬化性肾炎患儿经利妥昔单抗治疗后临床症状与体征减轻,B细胞数减少,Th细胞降低.利妥昔单抗对硬化性肾小球炎无理想治疗效果的患者提供一个新的方法.