Mak S K, Lo K Y, Lo M W, Chan S F, Lo K C, Wong Y Y, Tong Gensy M W, Wong P N, Ma Edmond S K, Wong Andrew K M
Renal Unit, Department of Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong.
Hong Kong Med J. 2009 Jun;15(3):201-8.
Plasmapheresis remains the main treatment modality for patients with thrombotic thrombocytopenic purpura. We report a patient who had simultaneous onset of membranoproliferative glomerulonephritis and thrombotic thrombocytopenic purpura. She did not improve after 48 plasmapheresis sessions. A 6-week course of weekly intravenous doses of rituximab was then given. This achieved complete remission of her nephrotic syndrome and improvement in her renal function, so plasmapheresis was ceased. She had a low ADAMTS13 antigen level and a positive ADAMTS13 antibody, both of which reverted to normal after treatment with rituximab. This coincided with a rise in her hepatitis C virus RNA and liver transaminases. Liver biopsies did not reveal active fibrosis. Her hepatitis C virus RNA titre dropped afterwards, and she had no relapses of her thrombotic thrombocytopenic purpura and nephrotic syndrome, for more than 2 years after remission. The simultaneous onset and successful outcomes of both the membranoproliferative glomerulonephritis and thrombotic thrombocytopenic purpura illustrate the usefulness of rituximab. We discuss its use and risks, in the context of chronic hepatitis C infection.
血浆置换仍然是血栓性血小板减少性紫癜患者的主要治疗方式。我们报告了一名同时发生膜增生性肾小球肾炎和血栓性血小板减少性紫癜的患者。在进行48次血浆置换治疗后，她的病情并未改善。随后给予了为期6周、每周静脉注射利妥昔单抗的疗程。这使她的肾病综合征完全缓解，肾功能得到改善，于是停止了血浆置换。她的ADAMTS13抗原水平较低且ADAMTS13抗体呈阳性，在用利妥昔单抗治疗后两者均恢复正常。这与她丙型肝炎病毒RNA和肝转氨酶升高同时出现。肝脏活检未发现活动性纤维化。之后她的丙型肝炎病毒RNA滴度下降，在缓解后2年多的时间里，她的血栓性血小板减少性紫癜和肾病综合征均未复发。膜增生性肾小球肾炎和血栓性血小板减少性紫癜的同时发生以及成功治疗结果说明了利妥昔单抗的有效性。我们在慢性丙型肝炎感染的背景下讨论了其使用方法和风险。
