贝利尤单抗治疗狼疮肾炎2例报告并文献复习

张娜; 孙文闻; 刘永玉; 巩路; 魏蔚

doi:10.16766/j.cnki.issn.1674-4152.002483

贝利尤单抗治疗狼疮肾炎2例报告并文献复习

doi: 10.16766/j.cnki.issn.1674-4152.002483

张娜¹,
孙文闻¹,
刘永玉²,
巩路¹,
魏蔚^1, ,

1.
天津医科大学总医院风湿免疫科天津市免疫系统疾病临床医学研究中心，天津 300052
2.
天津医科大学教务处，天津 300052

详细信息

通讯作者:
魏蔚，E-mail：tjweiwei2003@163.com

中图分类号: R593.24
计量
- 文章访问数: 145
- HTML全文浏览量: 53
- PDF下载量: 26
- 被引次数: 0
出版历程
- 收稿日期: 2021-06-24
- 网络出版日期: 2022-09-05

摘要

- 贝利尤单抗 /
- 狼疮肾炎 /
- 红斑狼疮 /
- 系统性

HTML全文

表 1 2例狼疮肾炎患者临床表现、实验室检查及治疗情况

Table 1. Clinical manifestations, laboratory examination and treatment of 2 patients with lupus nephritis

患者	时间	SELENA-SLEDAI计分(分)	临床表现(皮肤黏膜关节)	实验室检查						治疗
患者	时间	SELENA-SLEDAI计分(分)	临床表现(皮肤黏膜关节)	尿蛋白/肌酐(mg/mmol)	肌酐清除率(mL/min)	尿RBC(/HP)	尿WBC(/HP)	补体C3(g/L)	抗dsDNA抗体(IU/mL)	激素(mg)	合并用药
病例1	基线	12	皮疹，脱发	120.93	105	1~3	10~15	0.67	426	10.0	MMF 1.5 g/d，HCQ 200 mg/d，福辛普利5 mg/d
	12周	8	皮疹，脱发	49.89	163	1~3	1~3	0.64	163	10.0
	24周	10	脱发	66.52	163	0	0~1	0.43	227	10.0
	36周	6	脱发	38.35	148	0~1	0~1	0.81	221	10.0
	48周	6	脱发	41.18	160	0~1	0~1	0.87	185	10.0
病例2	基线	10	脱发，关节炎	153.73	112	1~3	1~3	1.37	6	7.5	MMF 1.5 g/d，HCQ 200 mg/d
	12周	6	脱发	120.93	110	0~1	10~15(经期)	1.54	< 6	5.0
	24周	4	脱发，皮疹	32.69	108	0	0~1	1.49	6	5.0
	36周	2	脱发	24.77	109	1~3	15~25(经期)	1.43	< 6	3.3
	48周	2	脱发	31.33	142	0~1	0	1.48	< 6	2.0	HCQ 200 mg/d
注：尿蛋白/肌酐参考值为1.70~24.89 mg/mmol，肌酐清除率参考值为75~115 mL/min，尿RBC参考值为0~3/HP，尿WBC参考值为0~10/HP，补体C3参考值为0.90~1.80 g/L，抗dsDNA抗体参考值为 < 30 IU/mL，激素相当于泼尼松(mg)。MMF为吗替麦考酚酯，HCQ为羟氯喹。

下载: 导出CSV

参考文献(17)

[1]	中华医学会风湿病学分会, 国家皮肤与免疫疾病临床医学研究中心, 中国系统性红斑狼疮研究协作组, 等. 2020中国系统性红斑狼疮诊疗指南[J]. 中华内科杂志, 2020, 59(3): 172-185. doi: 10.3760/cma.j.issn.0578-1426.2020.03.002 Chinese Rheumatology Association, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Systemic Lupus Erythematosus Treatment and Research Group, et al. 2020 Chinese guidelines for the diagnosis and treatment of systemic lupus erythematosus[J]. Chinese Rheumatology Association; National Clinical Research Center for Dermatologic and Immunologic Diseases; Chinese Systemic Lupus Erythematosus Treatment and Research Group, 2020, 59(3): 172-185. doi: 10.3760/cma.j.issn.0578-1426.2020.03.002
[2]	CASSIA M, ALBERICI F, GALLIENI M, et al. Lupus nephritis and B-cell targeting therapy[J]. Expert Rev Clin Immunol, 2017, 13(10): 951-962. doi: 10.1080/1744666X.2017.1366855
[3]	ZHANG F C, BAE S C, BASS D, et al. A pivotal phase Ⅲ, randomised, placebo-controlled study of belimumab in patients with systemic lupus erythematosus located in China, Japan and South Korea[J]. Ann Rheum Dis, 2018, 77(3): 355-363. doi: 10.1136/annrheumdis-2017-211631
[4]	中国狼疮肾炎诊断和治疗指南编写组. 中国狼疮肾炎诊断和治疗指南[J]. 中华医学杂志, 2019, 99(44): 3441-3455. doi: 10.3760/cma.j.issn.0376-2491.2019.44.001 Chinese Lupus nephritis Diagnosis and Treatment Guideline Compilation Group. Chinese Guidelines for the diagnosis and treatment of lupus nephritis[J]. National Medical Journal of China, 2019, 99(44): 3441-3455. doi: 10.3760/cma.j.issn.0376-2491.2019.44.001
[5]	谢长好, 李志军. 系统性红斑狼疮的诊断与治疗[J]. 中华全科医学, 2020, 18(4): 527-528. http://www.zhqkyx.net/article/id/240c4592-9f47-4c70-a324-2bf8221505c8 XIE C H, LI Z J. Diagnosis and treatment of systemic lupus erythematosus[J]. Chinese general practice, 2020, 18(4): 527-528. http://www.zhqkyx.net/article/id/240c4592-9f47-4c70-a324-2bf8221505c8
[6]	ANDERS H J, SAXENA R, ZHAO M H, et al. Lupus nephritis[J]. Nat Rev Dis Primers, 2020, 6(1): 7. doi: 10.1038/s41572-019-0141-9
[7]	KRONBICHLER A, BREZINA B, GAUCKLER P, et al. Refractory lupus nephritis: When, why and how to treat[J]. Autoimmun Rev, 2019, 18(5): 510-518. doi: 10.1016/j.autrev.2019.03.004
[8]	MURPHY G, ISENBERG D A. New therapies for systemic lupus erythematosus: Past imperfect, future tense[J]. Nat Rev Rheumatol, 2019, 15(7): 403-412. doi: 10.1038/s41584-019-0235-5
[9]	SAMY E, WAX S, HUARD B, et al. Targeting BAFF and APRIL in systemic lupus erythematosus and other antibody-associated diseases[J]. Int Rev Immunol, 2017, 36(1): 3-19. doi: 10.1080/08830185.2016.1276903
[10]	BLAIR H A, DUGGAN S T. Belimumab: A review in systemic lupus erythematosus[J]. Drugs, 2018, 78(3): 355-366. doi: 10.1007/s40265-018-0872-z
[11]	FANOURIAKIS A, KOSTOPOULOU M, ALUNNO A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus[J]. Ann Rheum Dis, 2019, 78(6): 736-745. doi: 10.1136/annrheumdis-2019-215089
[12]	ADAMICHOU C, GEORGAKIS S, BERTSIAS G. Cytokine targets in lupus nephritis: Current and future prospects[J]. Clin Immunol, 2019, 206: 42-52. doi: 10.1016/j.clim.2018.08.013
[13]	FURIE R, ROVIN BN, HOUSSIAU F, et al. Two-year, randomized, controlled trial of belimumab in lupus nephritis[J]. N Engl J Med, 2020, 383(12): 1117-1128. doi: 10.1056/NEJMoa2001180
[14]	BINDA V, TREZZI B, DEL P N, et al. Belimumab may decrease flare rate and allow glucocorticoid withdrawal in lupus nephritis (including dialysis and transplanted patient)[J]. J Nephrol, 2020, 33(5): 1019-1025. doi: 10.1007/s40620-020-00706-3
[15]	MARGIOTTA D P E, BASTA F, BATANI V, et al. Belimumab and low-doses of mycophenolate mofetil as induction therapy of class Ⅳ lupus nephritis: Case series and literature review[J]. BMC Nephrol, 2018, 19(1): 54. doi: 10.1186/s12882-018-0847-z
[16]	SCIASCIA S, RADIN M, YAZDANY J, et al. Efficacy of belimumab on renal outcomes in patients with systemic lupus erythematosus: A systematic review[J]. Autoimmun Rev, 2017, 16(3): 287-293. doi: 10.1016/j.autrev.2017.01.010
[17]	FLIEBER E E, KORSTEN P, KOZIOLEK M J, et al. Successful treatment of a mycophenolate mofetil-refractory proliferative lupus nephritis with Belimumab in a 19-year-old woman[J]. Lupus, 2013, 22(14): 1523-1525. doi: 10.1177/0961203313504145