利妥昔单抗联合血浆置换治疗难治性系统性红斑狼疮肾炎合并血栓性微血管病的临床研究

Clinical efficacy of rituximab combined with plasma exchange in the treatment of refractory lupus nephritis complicated with thrombotic microangiopathy

摘要:

目的 探讨利妥昔单抗联合血浆置换治疗难治性系统性红斑狼疮肾炎合并血栓性微血管病（TMA）的临床疗效。方法 选取2022年1月—2024年6月西安大兴医院收治的86例难治性系统性红斑狼疮肾炎合并TMA患者，采用随机数字表法分为两组，对照组为常规治疗联合血浆置换（43例），观察组为对照组基础上加用利妥昔单抗（43例）。比较两组患者的临床疗效、疾病活动度指标、肾脏损伤指标、炎症指标、免疫学指标及不良反应发生情况。结果 观察组总有效率高于对照组（P <0.05）。观察组治疗前后系统性红斑狼疮疾病活动指数评分、抗双链DNA抗体阳性率、24 h尿蛋白定量、血清肌酐、血尿素氮、尿红细胞计数、白细胞介素-6、C-反应蛋白、肿瘤坏死因子-α、免疫球蛋白G、免疫球蛋白A、免疫球蛋白M的差值均大于对照组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 利妥昔单抗联合血浆置换可显著改善难治性系统性红斑狼疮肾炎合并TMA患者的肾功能及微血管病变，减轻炎症反应，且安全性良好，值得临床推广。

Abstract:

Objective To investigate the clinical efficacy of rituximab combined with plasma exchange (PEX) in the treatment of refractory lupus nephritis (LN) complicated with thrombotic microangiopathy (TMA).Methods A total of 86 patients with refractory LN and TMA admitted to Daxing Hospital from January 2022 to June 2024 were selected and divided into two groups using the random number table method. The control group received conventional therapy combined with PEX (n = 43), and the observation group additionally received the rituximab (n = 43). Clinical efficacy, disease activity indicators, renal function markers, inflammatory and immunological indicators, and adverse events were compared between the two groups.Results The overall effective rate was higher in the observation group than in the control group (P < 0.05). The changes from pre- to post-treatment in SLEDAI scores, anti-double-stranded DNA antibody positivity, 24-hour urine protein, serum creatinine, blood urea nitrogen, urinary red blood cell count, interleukin-6, C-reactive protein, tumor necrosis factor-α, immunoglobulin G, immunoglobulin A, and immunoglobulin M were all greater in the observation group than in the control group (P < 0.05). There was no significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusion Rituximab combined with PEX significantly improves renal function, mitigates microvascular lesions, reduces inflammatory responses, and demonstrates a favorable safety profile in patients with refractory LN and TMA, supporting its clinical application.