利妥昔单抗治疗原发性干燥综合征合并间质性肺病：一项回顾性队列研究。

Rituximab therapy in primary Sjögren's syndrome with interstitial lung disease: a retrospective cohort study.

作者信息

Chen Ming-Han, Chen Chun-Ku, Chou Hsiao-Ping, Chen Ming-Huang, Tsai Chang-Youh, Chang Deh-Ming

机构信息

Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei; and Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.

Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.

出版信息

Clin Exp Rheumatol. 2016 Nov-Dec;34(6):1077-1084. Epub 2016 Aug 31.

DOI:

PMID:27607895

Abstract

OBJECTIVES

Interstitial lung disease (ILD) is one of the major systemic manifestations of primary Sjögren's syndrome (pSS). The aim of this study was to evaluate the therapeutic effect of rituximab on pSS patients with ILD.

METHODS

Pulmonary function test results, including diffusing capacity for carbon monoxide (DLCO) and DLCO/alveolar volume (Va) ratio, and high-resolution computed tomography (HRCT) findings/scores in ten pSS patients with ILD treated with rituximab were retrospectively investigated. Global disease, fatigue, dryness of eyes and mouth, shortness of breath, and cough were assessed by visual analogue scales (VAS, 0-100 mm).

RESULTS

At 6 months after rituximab treatment, improvement in pulmonary function was observed (from 49.3±12.6 to 56.9±11.4% for DLCO, p=0.011; from 74.4±15.8 to 85.6±10.3% for DLCO/Va, p=0.021). Similarly, significant improvement of subjective symptoms were also noted after treatment (VAS global disease, from 62.0±11.4 to 26.0±10.8 mm, p<0.001; VAS fatigue, from 38.0±23.0 to 18.0±7.9 mm, p=0.006; VAS dryness of eyes, from 53.0±24.4 to 29.0±13.7 mm, p=0.004; VAS dryness of mouth, from 45.0±14.3 to 28.0±9.2 mm, p=0.001; VAS shortness of breath, from 64.0±16.5 to 31.0±16.0 mm, p<0.001; VAS cough, from 42.0±23.5 to 18.0±10.3 mm, p=0.011). The mean HRCT score decreased after rituximab therapy although to a lesser extent (from 8.7±4.1 to 7.6±4.6, p=0.419). An adverse event was observed in only one patient who had non-fatal pneumonia 4 months after rituximab infusion.

CONCLUSIONS

Rituximab was effective in improving clinical symptoms and gas exchange, and in stabilising HRCT score in pSS patients with ILD.

摘要

目的

间质性肺病（ILD）是原发性干燥综合征（pSS）的主要全身表现之一。本研究旨在评估利妥昔单抗对pSS合并ILD患者的治疗效果。

方法

回顾性研究了10例接受利妥昔单抗治疗的pSS合并ILD患者的肺功能测试结果，包括一氧化碳弥散量（DLCO）和DLCO/肺泡容积（Va）比值，以及高分辨率计算机断层扫描（HRCT）表现/评分。采用视觉模拟量表（VAS，0-100mm）评估整体疾病、疲劳、眼干、口干、气短和咳嗽情况。

结果

利妥昔单抗治疗6个月后，观察到肺功能有所改善（DLCO从49.3±12.6%提高到56.9±11.4%，p=0.011；DLCO/Va从74.4±15.8%提高到85.6±10.3%，p=0.021）。同样，治疗后主观症状也有显著改善（VAS整体疾病评分从62.0±11.4mm降至26.0±10.8mm，p<0.001；VAS疲劳评分从38.0±23.0mm降至18.0±7.9mm，p=0.006；VAS眼干评分从53.0±24.4mm降至29.0±13.7mm，p=0.004；VAS口干评分从45.0±14.3mm降至28.0±9.2mm，p=0.001；VAS气短评分从64.0±16.5mm降至31.0±16.0mm，p<0.001；VAS咳嗽评分从42.0±23.5mm降至18.0±10.3mm，p=0.011）。利妥昔单抗治疗后平均HRCT评分有所下降，尽管下降幅度较小（从8.7±4.1降至7.6±4.6，p=0.419）。仅1例患者在输注利妥昔单抗4个月后发生非致命性肺炎这一不良事件。