Remuzzi Giuseppe, Chiurchiu Carlos, Abbate Mauro, Brusegan Verusca, Bontempelli Mario, Ruggenenti Piero
Ospedali Riuniti Di Bergam, Unit of Nephrology and Dialysis, Aldo and Cele Daccò Clinical Research Centre for Diseases, Mario Negri Institute for Parmacological Research, Via Gavazzeni 1124125, Bergamo, Italy.
Lancet. 2002 Sep 21;360(9337):923-4. doi: 10.1016/S0140-6736(02)11042-7.
Treatments for idiopathic membranous nephropathy, a common cause of nephrotic syndrome, can be very toxic. In view of the pathogenic potential of B cells in this disease, we studied the effects of four weekly infusions of rituximab (375 mg/m(2)-- the monoclonal antibody to B-cell antigen CD20--in eight patients who had idiopathic membranous nephropathy with persistent nephrotic syndrome. At weeks 4 and 20, urinary protein decreased from mean (SE) 8.6 g/24 h (1.4) to 3.8 (0.8) and 3.7 (0.9), respectively (p<0.0001). At week 20, albuminuria and albumin fractional clearance decreased by 70% and 65%, and serum albumin increased by 31%. CD20 B lymphocytes fell below normal ranges up to study end. The short-term risk-benefit profile of rituximab seems more favourable to that of any other immunosuppressive drug used to treat idiopathic membranous nephropathy.
特发性膜性肾病是肾病综合征的常见病因，其治疗方法可能具有很强的毒性。鉴于B细胞在该疾病中的致病潜力，我们对8例患有特发性膜性肾病且持续性肾病综合征的患者进行了研究，给予他们每周一次、共四次的利妥昔单抗（375 mg/m²，一种针对B细胞抗原CD20的单克隆抗体）静脉输注治疗。在第4周和第20周时，尿蛋白分别从平均（标准误）8.6 g/24小时（1.4）降至3.8（0.8）和3.7（0.9）（p<0.0001）。在第20周时，蛋白尿和白蛋白分数清除率分别下降了70%和65%，血清白蛋白增加了31%。直至研究结束，CD20 B淋巴细胞数量均低于正常范围。与用于治疗特发性膜性肾病的任何其他免疫抑制药物相比，利妥昔单抗的短期风险效益比似乎更为有利。
