系统性硬化症患者长期使用利妥昔单抗治疗期间的肾功能

M. N. Starovoitova, O. V. Desinova, L. P. Ananyeva, O. A. Koneva, L. A. Garzanova, O. B. Ovsyannikova, R. U. Shayakhmetova
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摘要

在系统性硬化(SSc)中,不同类型的肾脏受累发生。其严重程度可以从无症状的肾功能恶化到危及生命的损害,这是一个复杂的治疗问题。利妥昔单抗(Rituximab, RTM)已被用于治疗SSc和其他自身免疫性疾病,并取得了良好的效果,但其对肾功能的影响尚未得到充分的研究。目的:通过长期随访(至少1年)评估SSc患者在包括RTM在内的综合治疗期间的肾功能。材料和方法。该研究纳入了90例SSc患者,他们在RTM治疗开始前和开始后1-3.5年至少接受了两次检查。根据CKD-EPI公式计算肾小球滤过率(GFR)评估肾功能。还测定了慢性肾病(CKD)的分期、血压、每日蛋白尿、皮肤评分、活动性和肺功能指标——肺活量和肺弥散能力。结果和讨论。在RTM联合治疗的背景下,观察结束时,全组患者GFR均有统计学意义的下降。另一方面,大多数最初保存GFR的患者的肾功能保持稳定,CKD患者的数量从20例减少到15例,减少了25%。在超过一半的最初患有CKD的患者中,GFR在治疗后增加(n = 11)或稳定(n = 2),只有7例患者GFR在统计学上不显著地下降,而只有2例患者观察到CKD发展到更晚期。本文对2例既往患有硬皮病肾危象(SRC)的患者的治疗结果进行了详细的回顾。结论。本研究中,RTM治疗对GFR和CKD分级无显著影响。大多数患者肾功能稳定;初始低级别CKD患者表现出肾功能稳定的趋势。在整个患者组中,长期治疗期间GFR的显著下降似乎可以解释为初始严重硬皮病肾损害患者肾功能不全的增加,特别是由于SRC。RTM治疗对SSc患者肾功能的影响有待进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Renal function during long-term therapy with rituximab in patients with systemic sclerosis
In systemic sclersis (SSc), different types of renal involvement occur. Their severity can range from asymptomatic deterioration of renal function to life-threatening damage, which is a complex therapeutic problem. Rituximab (RTM) has been used in the treatment of SSc and other autoimmune diseases with promising results, but its effect on renal function has not been adequately studied. Objective: to evaluate the renal function during complex therapy, including RTM, in patients with SSc over a long-term follow-up (at least 1 year). Material and methods. The study included 90 patients with SSc who were examined at least twice – before and 1–3.5 years after initiation of RTM treatment. Renal function was assessed by glomerular filtration rate (GFR) calculated according to the CKD-EPI formula. The stages of chronic kidney disease (CKD), blood pressure, daily proteinuria, skin score, activity, and indicators of lung function – forced vital capacity and diffusing capacity of the lungs – were also determined. Results and discussion. Against the background of complex therapy with RTM, there was a statistically significant decrease in GFR in the entire group of patients at the end of observation. On the other hand, renal function remained stable in the majority of patients with initially preserved GFR and there was a 25 % decrease – from 20 to 15 patients – in the number of patients with CKD. In more than half of the patients who initially had CKD, GFR increased (n = 11) or stabilized (n = 2) after therapy, and it decreased in a statistically insignificant manner in only 7 patients, whereas the development of a more advanced stage of CKD was observed in only 2 cases. The results of the treatment of 2 patients who had previously experienced scleroderma renal crisis (SRC) are reviewed in detail. Conclusion. In this study, there was no significant effect of RTM treatment on GFR and grade of CKD. Most patients had stable renal function; patients with an initial low grade of CKD showed a tendency toward stabilization of renal function. A significant decrease in GFR during long-term therapy noted in the entire patient group appears to be explained by an increase in renal insufficiency in patients with initially severe scleroderma renal damage, particularly due to SRC. Further studies on the effects of RTM therapy on renal function in patients with SSc are needed.
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