Zhang Jin, Zhao Zhanzheng, Hu Xiaozhou
Department of Nephrology, The 5th Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
Department of Nephrology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
Cell Biochem Biophys. 2015 May;72(1):197-201. doi: 10.1007/s12013-014-0437-z.
The objective of this study was to analyze and compare the effects of rituximab (RTX) and cyclophosphamide (CTX) on the serum levels of anti-C1q antibodies and antineutrophil cytoplasmic autoantibodies (ANCA) in assessing the prognosis of severe and refractory lupus nephritis (LN). Eighty-four cases of severe and refractory LN were randomly divided into two groups of 42 cases each: CTX group and RTX group (CTX+RTX) during February 2010 to February 2014 in our hospital. Changes in serum levels of anti-C1q antibodies and ANCA in the two groups were examined, and efficacies of the drugs were compared. The total efficacy of RTX group was found to be 83.3 %, which was significantly higher than that of the CTX group, 57.1 % (p < 0.05). The serum anti-C1q antibodies and ANCA were decreased to 11.9 and 26.2 % in the RTX-treated group, which was significantly lower than those observed in the CTX-treated patients (21.4 and 69.0 % respectively) (p < 0.05). The clinical indices of LN were significantly improved in the two groups after the treatment. However, the urinary protein, albumin, complement C3, the percentage of CD19(+)B cells, and SLEDAI scores in the RTX group were significantly lower than those in the CTX group (p < 0.05). RTX plus with CTX showed a better therapeutic efficacy compared to CTX, and it significantly improved the prognosis of refractory and severe LN. The improvement in disease prognosis was directly related to the reduced serum levels of anti-C1q and ANCA measured during the course of treatment suggesting that they can serve to be valuable biomarkers of LN prognosis. Moreover, the measurement can assist in the judgment of RTX efficacy guiding the adjustment of the drug dose to improve the quality of life.
本研究的目的是分析和比较利妥昔单抗（RTX）和环磷酰胺（CTX）对血清抗C1q抗体和抗中性粒细胞胞浆自身抗体（ANCA）水平的影响，以评估重症和难治性狼疮性肾炎（LN）的预后。2010年2月至2014年2月，我院84例重症和难治性LN患者被随机分为两组，每组42例：CTX组和RTX组（CTX + RTX）。检测两组血清抗C1q抗体和ANCA水平的变化，并比较药物疗效。结果发现RTX组的总有效率为83.3%，显著高于CTX组的57.1%（p < 0.05）。RTX治疗组血清抗C1q抗体和ANCA分别降至11.9%和26.2%，显著低于CTX治疗患者（分别为21.4%和69.0%）（p < 0.05）。治疗后两组LN的临床指标均有显著改善。然而，RTX组的尿蛋白、白蛋白、补体C3、CD19(+)B细胞百分比和SLEDAI评分显著低于CTX组（p < 0.05）。与CTX相比，RTX联合CTX显示出更好的治疗效果，显著改善了难治性和重症LN的预后。疾病预后的改善与治疗过程中血清抗C1q和ANCA水平的降低直接相关，表明它们可作为LN预后的有价值生物标志物。此外，该检测有助于判断RTX疗效，指导调整药物剂量，提高生活质量。
