儿童原发性肾病综合征小剂量利妥昔单抗维持治疗的临床研究

彭文婷; 李晓忠

doi:10.7499/j.issn.1008-8830.2409131

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中国当代儿科杂志 ›› 2025, Vol. 27 ›› Issue (8) : 982-988. DOI: 10.7499/j.issn.1008-8830.2409131

论著·临床研究

儿童原发性肾病综合征小剂量利妥昔单抗维持治疗的临床研究

彭文婷 ¹^,² ,
李晓忠 ²

作者信息 +

Clinical study on low-dose rituximab maintenance therapy in children with primary nephrotic syndrome

Wen-Ting PENG ¹^,² ,
Xiao-Zhong LI ²

Author information +

文章历史 +

摘要

目的探讨儿童原发性肾病综合征（primary nephrotic syndrome, PNS）小剂量利妥昔单抗（rituximab, RTX）（<375 mg/m²）维持治疗的临床疗效及安全性。方法对2016年7月—2024年3月在苏州大学附属儿童医院肾脏免疫科接受小剂量RTX治疗的PNS患儿的临床资料进行回顾性分析，分析RTX治疗前后的缓解率、复发次数、激素及他克莫司的用药情况、不良反应等差异。结果与治疗前相比，小剂量RTX可维持PNS缓解状态，减少复发次数及减少激素和他克莫司的使用剂量（P<0.05），免疫球蛋白G水平无明显降低，无需额外预防感染治疗。结论小剂量RTX治疗儿童PNS的效果较好，安全性较高。

Abstract

Objective To investigate the clinical efficacy and safety of low-dose rituximab (RTX) (<375 mg/m²) maintenance therapy in children with primary nephrotic syndrome (PNS). Methods A retrospective analysis was conducted on the clinical data of PNS children who received low-dose RTX therapy at the Department of Renal Immunology, Children's Hospital of Soochow University from July 2016 to March 2024. Remission rate, recurrence frequency, corticosteroid and tacrolimus usage, and adverse reactions before and after RTX treatment were analyzed. Results Compared with before treatment, low-dose RTX maintained remission in PNS, reduced the relapse frequency, and decreased the dosage of corticosteroids and tacrolimus (P<0.05). IgG levels did not significantly decrease, and no additional preventive anti-infective treatment was required. Conclusions Low-dose RTX therapy is effective and safe for treating PNS in children.

导出引用

彭文婷, 李晓忠. 儿童原发性肾病综合征小剂量利妥昔单抗维持治疗的临床研究[J]. 中国当代儿科杂志. 2025, 27(8): 982-988 https://doi.org/10.7499/j.issn.1008-8830.2409131

Wen-Ting PENG, Xiao-Zhong LI. Clinical study on low-dose rituximab maintenance therapy in children with primary nephrotic syndrome[J]. Chinese Journal of Contemporary Pediatrics. 2025, 27(8): 982-988 https://doi.org/10.7499/j.issn.1008-8830.2409131

参考文献

列表( 原文顺序 | 文献年度倒序 | 文中引用次数倒序 ) 可视化分析

[1]	中华医学会儿科学分会肾脏学组. 儿童激素敏感、复发/依赖肾病综合征诊治循证指南（2016）[J]. 中华儿科杂志, 2017, 55(10): 729-734. DOI: 10.3760/cma.j.issn.0578-1310.2017.10.003 . https://www.ncbi.nlm.nih.gov/pubmed/29050108 本文引用 [3]

[2]

Trautmann

, Boyer

, Hodson

, et al. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome[J]. Pediatr Nephrol, 2023, 38(3): 877-919. PMCID: PMC9589698. DOI: 10.1007/s00467-022-05739-3 .

https://www.ncbi.nlm.nih.gov/pubmed/36269406

本文引用 [1]

[3]	Disease Kidney : Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases[J]. Kidney Int, 2021, 100(4S): S1-S276. DOI: 10.1016/j.kint.2021.05.021 . https://www.ncbi.nlm.nih.gov/pubmed/34556256 本文引用 [1]

[4]	Croitoru A, Balgradean M. Treatment-associated side effects in patients with steroid-dependent nephrotic syndrome[J]. Maedica (Bucur), 2022, 17(2): 285-290. PMCID: PMC9375867. DOI: 10.26574/maedica.2022.17.2.285 . https://www.ncbi.nlm.nih.gov/pubmed/36032609 本文引用 [1]

[5]	Nagai K. Immunosuppressive agent options for primary nephrotic syndrome: a review of network meta-analyses and cost-effectiveness analysis[J]. Medicina (Kaunas), 2023, 59(3): 601. PMCID: PMC10054564. DOI: 10.3390/medicina59030601 . https://www.ncbi.nlm.nih.gov/pubmed/36984602 本文引用 [1]

[6]	Horinouchi T, Nozu K, Iijima K. An updated view of the pathogenesis of steroid-sensitive nephrotic syndrome[J]. Pediatr Nephrol, 2022, 37(9): 1957-1965. PMCID: PMC9307535. DOI: 10.1007/s00467-021-05401-4 . https://www.ncbi.nlm.nih.gov/pubmed/35006356 本文引用 [1]

[7]	中华医学会肾脏病学分会专家组. 利妥昔单抗在肾小球肾炎中应用的专家共识[J]. 中华肾脏病杂志, 2022, 38(2): 151-160. DOI: 10.3760/cma.j.cn441217-20210615-00023 . 本文引用 [1]

[8]	利妥昔单抗在儿童激素敏感型肾病综合征中应用临床实践指南工作组. 利妥昔单抗在儿童激素敏感型肾病综合征中应用临床实践指南[J]. 中国循证儿科杂志, 2023, 18(4): 245-254. DOI: 10.3969/j.issn.1673-5501.2023.04.001 . 本文引用 [1]

[9]	Hogan J, Dossier C, Kwon T, et al. Effect of different rituximab regimens on B cell depletion and time to relapse in children with steroid-dependent nephrotic syndrome[J]. Pediatr Nephrol, 2019, 34(2): 253-259. DOI: 10.1007/s00467-018-4052-x . https://www.ncbi.nlm.nih.gov/pubmed/30109447 本文引用 [3]

[10]	黄敏, 王晓霞, 王晓春, 等. 极低剂量利妥昔单抗治疗原发性难治性肾病综合征的疗效及对肾功能、免疫球蛋白、Toll样受体的影响[J]. 临床肾脏病杂志, 2022, 22(10): 827-833. DOI: 10.3969/j.issn.1671-2390.2022.10.006 . 本文引用 [2]

[11]	朱颖, 吴琳, 王云, 等. 低剂量利妥昔单抗治疗儿童肾病综合征疗效及安全性的前瞻性随机对照研究[J]. 中国当代儿科杂志, 2023, 25(6): 606-611. PMCID: PMC10321428. DOI: 10.7499/j.issn.1008-8830.2301026 . https://www.ncbi.nlm.nih.gov/pubmed/37382130 本文引用 [4]

[12]	Benz K, Dötsch J, Rascher W, et al. Change of the course of steroid-dependent nephrotic syndrome after rituximab therapy[J]. Pediatr Nephrol, 2004, 19(7): 794-797. DOI: 10.1007/s00467-004-1434-z . https://www.ncbi.nlm.nih.gov/pubmed/15071769 本文引用 [1]

[13]	Zhang X, Jin Y, Li Q, et al. Successful treatment of new-onset pediatric nephrotic syndrome with rituximab as a first-line therapy[J]. Kidney Int Rep, 2022, 7(12): 2750-2751. PMCID: PMC9727513. DOI: 10.1016/j.ekir.2022.10.016 . https://www.ncbi.nlm.nih.gov/pubmed/36506238 本文引用 [1]

[14]	Liu J, Deng F, Wang X, et al. Early rituximab as an add-on therapy in children with the initial episode of nephrotic syndrome[J]. Kidney Int Rep, 2024, 9(5): 1220-1227. PMCID: PMC11069012. DOI: 10.1016/j.ekir.2024.02.1395 . https://www.ncbi.nlm.nih.gov/pubmed/38707815 本文引用 [1]

[15]	Bagga A, Sinha A, Moudgil A. Rituximab in patients with the steroid-resistant nephrotic syndrome[J]. N Engl J Med, 2007, 356(26): 2751-2752. DOI: 10.1056/NEJMc063706 . https://www.ncbi.nlm.nih.gov/pubmed/17596616 本文引用 [1]

[16]

Yokota

, Kamei

, Fujinaga

, et al. Efficacy of rituximab and risk factors for poor prognosis in patients with childhood-onset steroid-resistant nephrotic syndrome: a multicenter study[J]. Pediatr Nephrol, 2024, 39(10): 2979-2988. DOI: 10.1007/s00467-024-06422-5 .

https://www.ncbi.nlm.nih.gov/pubmed/38834892

本文引用 [1]

[17]

Gomes

, Mosca

, Bastos-Gomes

, et al. Rituximab therapy for childhood onset idiopathic nephrotic syndrome: experience of a Portuguese tertiary center[J]. J Bras Nefrol, 2023, 45(3): 326-334. PMCID: PMC10697169. DOI: 10.1590/2175-8239-JBN-2022-0056en .

https://www.ncbi.nlm.nih.gov/pubmed/36259942

本文引用 [2]

[18]	Chan EY, Yap DY, Colucci M, et al. Use of rituximab in childhood idiopathic nephrotic syndrome[J]. Clin J Am Soc Nephrol, 2023, 18(4): 533-548. PMCID: PMC10103321. DOI: 10.2215/cjn.08570722 . https://www.ncbi.nlm.nih.gov/pubmed/36456193 本文引用 [1]

[19]	Sinha A, Mathew G, Arushi A, et al. Sequential rituximab therapy sustains remission of nephrotic syndrome but carries high risk of adverse effects[J]. Nephrol Dial Transplant, 2023, 38(4): 939-949. DOI: 10.1093/ndt/gfac228 . https://www.ncbi.nlm.nih.gov/pubmed/36071552 本文引用 [1]

[20]

Bonanni

, Calatroni

, D'Alessandro

, et al. Adverse events linked with the use of chimeric and humanized anti-CD20 antibodies in children with idiopathic nephrotic syndrome[J]. Br J Clin Pharmacol, 2018, 84(6): 1238-1249. PMCID: PMC5980330. DOI: 10.1111/bcp.13548 .

https://www.ncbi.nlm.nih.gov/pubmed/29436729

本文引用 [1]

[21]	Choi N, Min J, Kim JH, et al. Efficacy and safety of long-term repeated use of rituximab in pediatric patients with nephrotic syndrome[J]. Pediatr Nephrol, 2024, 39(3): 771-780. DOI: 10.1007/s00467-023-06124-4 . https://www.ncbi.nlm.nih.gov/pubmed/37682369 本文引用 [2]

[22]

Chan

, Yu

ELM

, Angeletti

, et al. Long-Term efficacy and safety of repeated rituximab to maintain remission in idiopathic childhood nephrotic syndrome: an international study[J]. J Am Soc Nephrol, 2022, 33(6): 1193-1207. PMCID: PMC9161790. DOI: 10.1681/asn.2021111472 .

https://www.ncbi.nlm.nih.gov/pubmed/35354600

本文引用 [2]