摘要
目的:观察临床表现为肾病综合征的磷脂酶A2受体(phospholipase A2 receptor,PLA2R)阴性的原发性膜性肾病(primary membranous nephropathy,PMN)患者使用利妥昔单抗(rituximab,RTX)的临床疗效,并分析疗效预测相关指标。方法:回顾性收集上海交通大学附属瑞金医院2020年3月至2024年3月间,经肾活检确诊为PLA2R阴性且临床表现为肾病综合征的19例PMN患者,所有患者均使用RTX治疗;同时匹配PLA2R阳性且临床表现为肾病综合征,并使用RTX治疗的38例PMN患者作为对照。最少随访6个月(中位12个月),观察这2组患者使用RTX的临床疗效,并分析可预测RTX治疗PLA2R阴性MN患者疗效的相关指标。结果:PLA2R阴性的PMN患者,采用RTX治疗12个月时,与基线相比,总体24 h尿蛋白定量从(9.8±4.3)g/d下降至(2.6±2.6)g/d,总体血清白蛋白从(20.3±4.3)g/L上升至(36.4±7.1)g/L(P<0.05),总体估算肾小球滤过率变化无统计学意义[(90.7±30.0)mL·min^(-1)·1.73m^(-2)比(84.4±22.19)mL·min^(-1)·1.73m^(-2)](P>0.05)。PLA2R阴性组总体缓解率在治疗3个月(57.89%)、6个月(57.89%)、12个月(85.71%)时与PLA2R阳性组相当(P>0.05)。治疗3个月及6个月时,PLA2R阴性组的完全缓解率高于PLA2R抗体阳性组(3个月时,21.5%比0,P=0.0098;6个月时36.84%比10.53%,P=0.0305),差异有统计学意义。单因素logistic回归分析显示,影响PLA2R阴性PMN患者RTX治疗12个月时临床缓解的变量包括,3个月时24 h尿蛋白定量(OR=0.993,P=0.0471)及3个月时血清白蛋白(OR=1.309,P=0.0488)。结论:RTX治疗PLA2R阴性的PMN有效,与PLA2R阳性组相比,治疗12个月时总缓解率相当,治疗3个月时完全缓解率略胜一筹。RTX治疗3个月时24 h尿蛋白定量及血清白蛋白水平可能作为PLA2R阴性PMN患者12个月时临床缓解情况的预测指标。
Objective To evaluate the clinical efficacy of rituximab(RTX)in patients with phospholipase A2 receptor(PLA2R)-negative primary membranous nephropathy(PMN)presenting as nephrotic syndrome,and to identify predictors for treatment efficacy.Methods This retrospective cohort study included 19 biopsy-proven PLA2R-negative PMN patients with nephrotic syndrome who received RTX at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine between March 2020 and March 2024.Additionally,38 PLA2R-positive PMN patients with nephrotic syndrome who received RTX were matched as controls.All patients were followed for at least 6 months(median=12 months)to evaluate the clinical efficacy of RTX in both groups and to analyze potential predictors of treatment efficacy in PLA2R-negative MN patients.Results In PLA2R-negative PMN patients treated with RTX for 12 months,the 24-hour proteinuria significantly decreased from(9.8±4.3)g/d to(2.6±2.6)g/d and serum albumin increased from(20.3±4.3)g/L to(36.4±7.1)g/L(P<0.05).The overall change in estimated glomerular filtration rate showed no statistical significance[(90.7±30.0)mL·min^(-1)·1.73 m^(-2) vs.(84.4±22.19)mL·min^(-1)·1.73 m^(-2)](P>0.05).Overall remission rates in the PLA2R-negative group at 3 months(57.89%),6 months(57.89%),12 months(85.71%)were comparable to those in the PLA2R-positive group(P>0.05).However,the complete remission rate was significantly higher in the PLA2R-negative group at 3 months(21.5%vs.0%,P=0.0098)and 6 months(36.84%vs.10.53%,P=0.0305),indicating statistical significance.The univariate logistic regression analysis showed that factors influencing clinical remission at 12 months of RTX treatment in PLA2R-negative PMN patients were 3-month 24-hour proteinuria(OR=0.993,P=0.0471)and 3-month serum albumin(OR=1.309,P=0.0488).Conclusion RTX treatment is effective in treating PLA2R-negative PMN.Compared with the PLA2R-positive group,the overall remission rate at 12 months was comparable,with a slightly higher complete remission rate at 3 months.The 3-month 24-hour proteinuria and 3-month serum albumin levels may serve as potential predictors for clinical remission at 12 months in PLA2Rnegative PMN patients.
作者
徐丽梨
胡晓帆
李灏
王伟铭
XU Lili;HU Xiaofan;LI Hao;WANG Weiming(Department of Nephrology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 201800,China)
出处
《诊断学理论与实践》
2025年第3期279-285,共7页
Journal of Diagnostics: Concepts & Practice
基金
国家自然科学基金(82070740)。
作者简介
通信作者:王伟铭,E-mail:weiming01@126.com。
