Shimizu Masaki, Yokoyama Tadafumi, Ishikawa Sayaka, Ueno Kazuyuki, Ohta Kazuhide, Yachie Akihiro
Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
Department of Pediatrics, Kanazawa Medical Center, Kanazawa, Japan.
CEN Case Rep. 2013 May;2(1):1-5. doi: 10.1007/s13730-012-0028-z. Epub 2012 Aug 9.
Rituximab (RTX) is a new steroid-sparing therapy for childhood steroid-dependent nephrotic syndrome (NS). However, relapses frequently occur immediately after CD19 recovery. We report the cases of two steroid-dependent NS patients treated with RTX followed by mizoribine (MZB). One patient relapsed, and the other developed proteinuria after CD19 recovery until the MZB was replaced by mycophenolate mofetil. These patients exhibited different lymphocyte phenotypes, with the CD4+/CD8+ profile favoring CD8+ T lymphocytes, while CD3+ HLA-DR-expressing activated T lymphocyte expansion occurred in the relapsed patient. Based on these findings, we suggest that T cell activation may influence outcome and that phenotypic analysis in addition to B cell monitoring may facilitate the detection of NS relapse.
利妥昔单抗（RTX）是一种用于儿童激素依赖型肾病综合征（NS）的新型激素替代疗法。然而，CD19恢复后复发常常立即出现。我们报告了两例接受RTX治疗后接着使用咪唑立宾（MZB）的激素依赖型NS患者的病例。一名患者复发，另一名患者在CD19恢复后出现蛋白尿，直到MZB被霉酚酸酯替代。这些患者表现出不同的淋巴细胞表型，CD4+/CD8+分布有利于CD8+ T淋巴细胞，而在复发患者中出现了表达CD3+HLA-DR的活化T淋巴细胞扩增。基于这些发现，我们认为T细胞活化可能影响治疗结果，除了监测B细胞外，表型分析可能有助于检测NS复发。
