目的 探討利妥昔單抗聯(lián)合氯沙坦鉀治療慢性腎小球腎炎的臨床療效。方法 選取2020年1月-2022年12月中國(guó)人民解放軍聯(lián)勤保障部隊(duì)第908醫(yī)院收治的105例慢性腎小球腎炎患者,依照隨機(jī)數(shù)字表法分為對(duì)照組(52例)和治療組(53例)。對(duì)照組口服氯沙坦鉀片,50 mg/次,1次/d。治療組在對(duì)照組治療基礎(chǔ)上靜脈滴注利妥昔單抗注射液,500 mg溶于10%葡萄糖溶液500 mL中,起始給藥速度為50 mg/h,1 h以后每半小時(shí)增加50 mg,1次/周。兩組連續(xù)治療12周。比較兩組的臨床療效,疲憊消失時(shí)間、浮腫消失時(shí)間及惡心嘔吐消失時(shí)間。比較兩組治療前后尿素氮(BUN)、血肌酐(Scr)、24 h尿蛋白、血管內(nèi)皮生長(zhǎng)因子(VEFG)、白細(xì)胞誘素-1(LKN-1)及白細(xì)胞介素-1β(IL-1β)水平變化情況。結(jié)果 治療后,治療組總有效率是94.34%,顯著高于對(duì)照組的78.85%(P<0.05)。治療后,治療組疲憊、浮腫、惡心嘔吐消失時(shí)間顯著短于對(duì)照組(P<0.05)。治療后,兩組BUN、Scr、24 h尿蛋白水平均較治療前顯著下降(P<0.05);且治療后,治療組BUN、Scr、24 h尿蛋白水平均顯著低于對(duì)照組(P<0.05)。治療后,兩組血清VEFG、LKN-1、IL-1β水平均顯著降低(P<0.05);治療后,治療組血清炎性因子水平均低于對(duì)照組(P<0.05)。結(jié)論 利妥昔單抗聯(lián)合氯沙坦鉀治療慢性腎小球腎炎的臨床療效較好,有助于減輕患者的臨床癥狀,改善腎功能,并能降低血清炎性因子水平,且具有較好的安全性。

Objective To investigate the clinical efficacy of rituximab combined with losartan potassium in treatment of chronic glomerulonephritis. Methods A total of 105 patients with chronic glomerulonephritis admitted to the 908 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force from January 2020 to December 2022 were selected and divided into control group (52 cases) and treatment group (53 cases) according to random number table method. Patients in the control group were po administered with Losartan Potassium Tablets, 50 mg/time, once daily. Patients in the treatment group were po administered with Rituximab Injection on the basis of the control group, 500 mg was dissolved in 10% glucose solution 500 mL, the initial administration rate was 50 mg/h, and 50 mg was increased every half hour after 1 h, once a week. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacy was evaluated, and fatigue disappearance time, edema disappearance time and nausea and vomiting disappearance time of the two groups were compared. The levels of urea nitrogen (BUN), serum creatinine (Scr), 24 h urinary protein, vascular endothelial growth factor (VEFG), leucoinducin-1 (LKN-1) and interleukin-1β (IL-1β) were compared between the two groups before and after treatment. Results After treatment, the total effective rate of the treatment group was 94.34%, which was significantly higher than that of the control group (78.85%, P < 0.05). After treatment, the disappearance time of fatigue, edema, nausea and vomiting in the treatment group was significantly shorter than that in the control group (P < 0.05). After treatment, BUN, Scr, and 24 h urinary protein levels in two groups were significantly decreased compared with before treatment (P < 0.05). After treatment, BUN, Scr, and 24 h urinary protein levels in treatment group were significantly lower than those in control group (P < 0.05). After treatment, serum levels of VEFG, LKN-1, and IL-1β were significantly decreased in both groups (P < 0.05). After treatment, the levels of serum inflammatory factors in the treatment group were lower than those in the control group (P < 0.05). Conclusion Rituximab combined with losartan potassium has good clinical effect in treatment of chronic glomerulonephritis, is helpful to reduce the clinical symptoms of patients, and can improve renal function, and can reduce the level of serum inflammatory factors, which has a good safety.

R983

江西省科技計(jì)劃項(xiàng)目(2020BBG70110)