关键词:

难治性原发性IgA肾病, 利妥昔单抗, 他克莫司, Gd-IgA1, 估计肾小球滤过率

Abstract:

Objective　To investigate the efficacy and safety of rituximab in the treatment of refractory primary immunoglobulin A (IgA) nephropathy. Methods　Seventy-three cases of refractory primary IgA nephropathy treated at Tongchuan People's Hospital and Xi'an International Medical Center Hospital from September 2021 to September 2023 were selected, and were divided into an experimental group of 38 cases and a control group of 35 cases based on the treatment methods. There were 19 males and 16 females in the control group, the age was (52.03±14.90) years old, the body mass index (BMI) was (23.17±1.25) kg/m², and the course of disease was (3.19±0.83) years. There were 23 males and 15 females in the experimental group, the age was (50.78±13.22) years old, the BMI was (23.52±1.17) kg/m², and the course of disease was (3.50±1.02) years. The control group was treated with oral methylprednisolone tablets combined with Tacrolimus capsules, and the experimental group received rituximab via intravenous infusion in addition to the treatment in the control group. After 3 cycles of treatment, the efficacy, adverse reactions, renal function [serum creatinine, 24 h urinary protein quantification, and estimated glomerular filtration rate (eGFR)], and immunological factors [IgA, IgG, and galactose-deficiency (Gd)-IgA1] were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　After 3 cycles of treatment, the levels of serum creatinine [(79.31±6.52) µmol/L] and 24 h urinary protein [(0.73±0.21) g] in the experimental group were lower than those in the control group [(83.06±7.14) µmol/L and (0.87±0.23) g], but the eGFR [(82.16±5.39) ml/(min·1.73 m²)] was higher than that in the control group [(79.04±5.51) ml/(min·1.73 m²)], with statistically significant differences (all P<0.05). After 3 cycles of treatment, the levels of IgA [(1.84±0.41) g/L] and IgG [(9.53±1.37) g/L] in the experimental group were higher than those in the control group [(1.53±0.38) g/L and (8.86±1.17) g/L], but the level of Gd-IgA1 [(6.23±0.95) mg/L] was lower than that in the control group [(7.01±1.59) mg/L], with statistically significant differences (all P<0.05). The total effective rate of the experimental group [89.47% (34/38)] was higher than that of the control group [65.71% (23/35)], with a statistically significant difference (P<0.05). There was no statistically significant difference in the total incidence of adverse drug reactions between the two groups (P>0.05). Conclusion　The combination of rituximab and Tacrolimus in the treatment of refractory primary IgA nephropathy has shown good efficacy and safety.

Key words:

Refractory primary IgA nephropathy, Rituximab, Tacrolimus, Gd IgA1, Estimated glomerular filtration rate