目的 探讨利妥昔单抗联合氯沙坦钾治疗慢性肾小球肾炎的临床疗效。方法 选取2020年1月-2022年12月中国人民解放军联勤保障部队第908医院收治的105例慢性肾小球肾炎患者,依照随机数字表法分为对照组(52例)和治疗组(53例)。对照组口服氯沙坦钾片,50 mg/次,1次/d。治疗组在对照组治疗基础上静脉滴注利妥昔单抗注射液,500 mg溶于10%葡萄糖溶液500 mL中,起始给药速度为50 mg/h,1 h以后每半小时增加50 mg,1次/周。两组连续治疗12周。比较两组的临床疗效,疲惫消失时间、浮肿消失时间及恶心呕吐消失时间。比较两组治疗前后尿素氮(BUN)、血肌酐(Scr)、24 h尿蛋白、血管内皮生长因子(VEFG)、白细胞诱素-1(LKN-1)及白细胞介素-1β(IL-1β)水平变化情况。结果 治疗后,治疗组总有效率是94.34%,显著高于对照组的78.85%(P<0.05)。治疗后,治疗组疲惫、浮肿、恶心呕吐消失时间显著短于对照组(P<0.05)。治疗后,两组BUN、Scr、24 h尿蛋白水平均较治疗前显著下降(P<0.05);且治疗后,治疗组BUN、Scr、24 h尿蛋白水平均显著低于对照组(P<0.05)。治疗后,两组血清VEFG、LKN-1、IL-1β水平均显著降低(P<0.05);治疗后,治疗组血清炎性因子水平均低于对照组(P<0.05)。结论 利妥昔单抗联合氯沙坦钾治疗慢性肾小球肾炎的临床疗效较好,有助于减轻患者的临床症状,改善肾功能,并能降低血清炎性因子水平,且具有较好的安全性。

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

江西省科技计划项目(2020BBG70110)