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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/m2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。
Objective To study the clinical application and significance of rituximab in children with sclerosing nephritis. Methods One case of sclerosing nephritis in children with Rituximab before using CD19, CD20, CD3, CD4, CD8, immunoglobulin quantitative, complement, blood, liver and kidney function and other indicators, half an hour before the drug intravenous injection of non The root 0.5 ~ 1 mg / kg, intravenous injection of dexamethasone 0.1 ~ 0.3 mg / kg 5 ~ 10 min before treatment; rituximab 375 mg / m2 diluted in 5% glucose solution 300 ml, intravenous drip. 1 month after the second application, a total of 2 times. Results Rituximab 2 weeks after the first intravenous drip eyelid edema and edema of both lower extremities reduced urinary protein 1 month to check [urine protein 2 +, 24 h urinary protein 0.68 g / L, urine NAG 17.2 U / (g.cr)], serum albumin increased, white blood cells and liver and kidney function had no effect; 1 week after the second intravenous drip eyelid edema and double lower extremity edema disappeared; 3 months urine protein was significantly reduced [urine Urinary protein quantitation was 0.32 g / L at 1 and 24 h, urine NAG enzyme concentration was 13.4 U / g.r.], serum albumin (35.2 g / L) and cholesterol (5.4 mmol / L) B lymphocyte depletion (CD8 + CD3 + 36.0%, Th: Ts 0.69; CD19 + 6 / μl, CD19 + Gate 0.3%, CD20 + 6 / μl, CD20 + Gate 0.3%), white blood cells and liver and kidney function had no effect. No adverse reactions. Conclusions Children with sclerosing nephritis after treatment with rituximab alleviate the clinical symptoms and signs, reduce the number of B cells, Th cells decreased. Rituximab for sclerotherapy of glomerulonephritis no ideal treatment of patients with a new method.