
奥妥珠单抗治疗利妥昔单抗抵抗性磷脂酶A2受体相关膜性肾病3例
郑振峰, 程茜, 齐焰, 商文雅, 韦丽, 李栋, 贾俊亚, 闫铁昆
奥妥珠单抗治疗利妥昔单抗抵抗性磷脂酶A2受体相关膜性肾病3例
Three cases of obinutuzumab treatment for rituximab-resistant phospholipase A2 receptor- associated membranous nephropathy
利妥昔单抗以其良好的有效性和安全性作为治疗磷脂酶A2受体(phospholipase A2 receptor, PLA2R)相关膜性肾病的一线治疗方案,尽管利妥昔单抗治疗后的缓解率超过60%,但仍有近40%患者对治疗无反应。现报道本中心应用奥妥珠单抗成功治疗利妥昔单抗抵抗性PLA2R相关膜性肾病3例,并探讨可能的机制。我们应用奥妥珠单抗治疗利妥昔单抗抵抗性PLA2R相关膜性肾病3例,经首剂1 000 mg追加或不追加剂量治疗后,患者抗PLA2R抗体和尿蛋白量明显下降,不良反应轻微。结果显示,奥妥珠单抗对利妥昔单抗抵抗性PLA2R相关膜性肾病具有一定的治疗效果,但随访观察时间尚短,只能作为个体案例参考,尚需要大样本、高质量的前瞻性队列研究加以证实。
Rituximab is currently used as a first-line therapy for phospholipase A2 receptor-associated membranous nephropathy due to its good efficacy and safety. Although the remission rate after rituximab treatment is more than 60%, nearly 40% patients still do not respond to treatment. We used obinutuzumab to treat 3 cases of rituximab resistant PLA2R-associated membranous nephropathy. After the first dose of 1 000 mg with or without additional dose, the amount of anti-PLA2R antibody and urinary protein decreased significantly and the adverse reactions were mild. The results show that obinutuzumab has a certain therapeutic effect on rituximab resistant PLA2R-associated membranous nephropathy, but the time of follow-up observation is short and can only be used as individual cases, which needs to be confirmed by a large sample and high-quality prospective cohort study.
受体,磷脂酶A2 / 肾小球肾炎,膜性 / 利妥昔单抗 / 奥妥珠单抗 / 缓解率 {{custom_keyword}} /
Receptors, phospholipase A2 / Glomerulonephritis, membranous / Rituximab / Obinutuzumab / Remission rate {{custom_keyword}} /
图2 患者随访血清抗磷脂酶A2受体(PLA2R)抗体水平与治疗的关系 |
表1 本中心和文献报道的应用奥妥珠单抗后血清抗磷脂酶A2受体(PLA2R)抗体滴度的变化 |
病例来源 | 病例 | 年龄(岁) | 性别 | 抗PLA2R抗体水平(RU/ml) | ||||
---|---|---|---|---|---|---|---|---|
基线 | 3个月 | 6个月 | 9个月 | 12个月 | ||||
本中心 | 病例1 | 56 | 男 | 270.47 | 80.40 | <2.00 | - | - |
本中心 | 病例2 | 64 | 男 | 44.36 | <2.00 | - | - | - |
本中心 | 病例3 | 64 | 女 | 5.50 | - | - | - | - |
Klomjit等[12] | 病例1 | 54 | 女 | 92.0 | - | - | - | 12.0 |
Klomjit等[12] | 病例2 | 61 | 男 | 125.0 | - | - | <2.0 | - |
Klomjit等[12] | 病例3 | 54 | 男 | 12.0 | - | <2.0 | <2.0 | <2.0 |
Sethi等[13] | 病例2 | 66 | 男 | 633.0 | 80.0 | 5.1 | - | - |
Sethi等[13] | 病例3 | 41 | 男 | 39.0 | 4.0 | - | - | 1.8 |
Sethi等[13] | 病例7 | 76 | 女 | 79.0 | 17.0 | 2.7 | - | 3.2 |
Sethi等[13] | 病例8 | 67 | 男 | 57.0 | 26.0 | 7.6 | - | - |
Hudson等[14] | 病例1 | 36 | 男 | 279.0 | - | - | - | <2.0 |
Hudson等[14] | 病例2 | 33 | 男 | 55.0 | - | - | <2.0 | <2.0 |
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http://journal.yiigle.com/LinkIn.do?linkin_type=cma&DOI=10.3760/cma.j.cn441217-20220620-00629
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