利妥昔单抗治疗严重感染背景下的抗中性粒细胞胞浆抗体相关性血管炎。
Rituximab for ANCA-associated vasculitis in the setting of severe infection.
机构信息
Department of Nephrology, Aarhus University Hospital, Denmark.
出版信息
Scand J Rheumatol. 2013;42(3):207-10. doi: 10.3109/03009742.2012.739638. Epub 2013 Jan 3.
OBJECTIVES
The combination of anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) and severe infection presents a challenge because current therapies with high-dose glucocorticoids and cyclophosphamide (CYC) are immunosuppressive and increase the risk of infection. Thus, coincident infection delays and complicates the introduction of treatment. Rituximab (RTX) is an alternative to CYC in AAV and may be preferable in the setting of severe infection.
METHOD
From 2005 to July 2011, 100 patients with AAV were treated with RTX at our institution and those who received RTX instead of CYC because of concomitant infection were studied.
RESULTS
Eight patients were identified. The mean follow-up was 12 months (range 6-30 months). All patients achieved remission by 6 months that was sustained to the end of follow-up. There were no deaths or further severe infections.
CONCLUSIONS
RTX can be considered for patients with generalized AAV and concomitant severe infection.
目的
抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）合并严重感染极具挑战性，因为目前采用大剂量糖皮质激素和环磷酰胺（CYC）的治疗方案具有免疫抑制作用，会增加感染风险。因此，并发感染会延迟和复杂化治疗的引入。利妥昔单抗（RTX）是 AAV 治疗的 CYC 替代药物，在严重感染的情况下可能更具优势。
方法
2005 年 7 月至 2011 年，我院对 100 例 AAV 患者采用 RTX 治疗，因并发感染而选择 RTX 而非 CYC 的患者被纳入研究。
结果
共确定了 8 例患者。中位随访时间为 12 个月（范围 6-30 个月）。所有患者在 6 个月内达到缓解，且缓解持续至随访结束。无死亡或进一步的严重感染。
结论
对于广泛性 AAV 合并严重感染的患者，可以考虑使用 RTX。
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