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Received:April 09, 2020 Published Online:November 20, 2020
Received:April 09, 2020 Published Online:November 20, 2020
中文摘要: 目的 探究采用利妥昔单抗辅助小剂量甲泼尼龙治疗特发性膜性肾病(IMN)对患者外周血维生素D结合蛋白(VDBP)、辅助性T细胞17(Th17)/调节性T细胞(Treg)水平的影响。方法 应用前瞻性随机对照研究方法选取2013年2月至2018年12月南方医科大学深圳医院门诊IMN患者72例,以随机数字表将患者分为联合组(n=36)和对照组(n=36)。常规治疗基础上,对照组给予小剂量甲泼尼龙,联合组给予利妥昔单抗辅助小剂量甲泼尼龙,均治疗6个月。比较两组疗效、不良反应,治疗前和治疗3、6个月血清白蛋白、肌酐,24 h尿蛋白定量,血脂指标［总胆固醇(TC)、三酰甘油(TG)］及外周血VDBP、Th17/Treg水平。结果 联合组治疗6个月后总有效率高于对照组(86.11% vs 63.89%,χ2=4.741,P<0.05)。两组血清白蛋白水平高于治疗前,且联合组高于对照组(P<0.05,P<0.01);24 h尿蛋白定量、TC、TG、外周血VDBP、Th17/Treg低于治疗前,且联合组低于对照组(P<0.05,P<0.01)。Pearson相关分析显示,外周血VDBP、Th17/Treg分别与血清白蛋白水平呈负相关,与24 h尿蛋白定量、TC、TG分别呈正相关(P<0.01)。两组不良反应发生率比较差异无统计学意义(19.44% vs 13.89%,χ2=0.400，P>0.05)。结论 利妥昔单抗辅助小剂量甲泼尼龙治疗IMN,可提高患者血清白蛋白水平,减少24 h尿蛋白定量,改善血脂水平,促进病情缓解,疗效显著,安全性高;或可通过降低VDBP、Th17/Treg发挥降脂、控制病情的作用。
Abstract:Objective To explore the efficacy of rituximab assisted low-dose methylprednisolone in the treatment of idiopathic membranous nephropathy (IMN) and its effect on the levels of peripheral blood vitamin D binding protein (VDBP),helper T cell 17 (Th17)/regulatory T cell (Treg).Methods A prospective randomized controlled study method was used to select 72 patients with IMN in the outpatient department of Shenzhen Hospital of Southern Medical University from February 2013 to December 2018.The patients were divided into combination group ( n=36) and control group ( n=36) according to random number table.On the basis of conventional treatment,the control group was given low-dose methylprednisolone,and the combination group was given rituximab combined low-dose methylprednisolone.Both were treated for 6 months.The efficacy and adverse reactions were compared,and serum albumin,creatinine,24 h urine protein quantification,blood lipid indexes ［total cholesterol (TC),triglycerides (TG)］,peripheral blood VDBP,Th17/Treg were detecded before treatment and 3,6 months after treatment.Results After 6 months of treatment,the total effective rate of combined group was higher than that of the control group (86.11% vs 63.89%, χ2=0.400, P <0.05).After treatment,serum albumin levels of the two groups were higher than that before treatment,and was higher in combination group than that in control group;24-hour urine protein quantification,TC,TG,peripheral blood VDBP,Th17/Treg were lower than those before treatment,and were lower in combination group than those in control group,the differences were statistically significant ( P <0.05, P<0.01).Peripheral blood VDBP and Th17/Treg were negatively correlated with serum albumin level,and positively correlated with 24-hour urine protein quantification,TC and TG ( P<0.01),respectively.There was no significant difference in the incidence of adverse reactions between the two groups (19.44% vs 13.89%, χ2=0.400， P >0.05).Conclusions Rituximab assisted with low-dose methylprednisolone in the treatment of IMN can increase the serum albumin level and reduce the 24-hour urine protein quantification,improve blood lipid levels,promote disease remission,and has significant curative effect,high safety,while the reduction of VDBP and Th17/Treg may be one of the mechanisms by which the two drugs exert lipid-lowering and disease-control functions.
keywords: Idiopathic membranous nephropathy Rituximab Methylprednisolone[DK],low-dose Vitamin D binding protein Helper T cell 17 Regulatory T cell
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基金项目:江苏省卫生厅资助基金项目(2017010221)
| Author Name | Affiliation |
| XU Jun*,HUANG Li,MOU Hong-bin | *Department of Nephrology,Subei People′s Hospital,Yangzhou,Jiangsu 225001,China |
| 黄莉2 | 2．南方医科大学深圳医院,广东 深圳 518100； |
| 牟洪宾1 | 1．苏北人民医院肾内科,江苏 扬州 225001 |
| Author Name | Affiliation |
| XU Jun*,HUANG Li,MOU Hong-bin | *Department of Nephrology,Subei People′s Hospital,Yangzhou,Jiangsu 225001,China |
| 黄莉2 | 2．南方医科大学深圳医院,广东 深圳 518100； |
| 牟洪宾1 | 1．苏北人民医院肾内科,江苏 扬州 225001 |
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