中国实用儿科杂志2025，Vol.40Issue(11)：909-917,9.DOI:10.19538/j.ek2025110608
利妥昔单抗联合霉酚酸酯或他克莫司在治疗儿童激素依赖型肾病综合征的有效性和安全性评估
Evaluation of the efficacy and safety of rituximab combined with mycophenolate mofetil or tacrolimus in the treatment of pediatric steroid-dependent nephrotic syndrome:a single-center retrospective study
摘要
Abstract
Objective To investigate the efficacy and safety of rituximab(RTX)combined with mycophenolate mofetil(MMF)or tacrolimus(TAC)in the treatment of pediatric steroid-dependent nephrotic syndrome(SDNS).Methods This retrospective cohort study enrolled 59 pediatric patients with steroid-dependent nephrotic syndrome(SDNS)who received their first rituximab(RTX)infusion at the Children's Hospital of Chongqing Medical University between October 2016 and August 2023.Demographic characteristics,corticosteroid usage,and laboratory parameters were collected.Participants were categorized into two groups based on post-RTX immunosuppressant regimens:mycophenolate mofetil(MMF)or tacrolimus(TAC).Overlap weighting was applied to balance baseline characteristics.Weighted Kaplan-Meier analysis was used to compare relapse rates between the two groups,while weighted Cox regression models were employed to evaluate differences in corticosteroid use.Multivariable Cox regression analysis was used to identify the factors affecting disease relapse following initial RTX treatment.Results The cohort comprised 59 patients(46 male,13 female)with a median age of 3.9 years(IQR 2.5,5.9)at disease onset and a median age of 10.5 years(IQR 7.6,12.6)at RTX initiation.Participants were divided into MMF group(n=23)and TAC(n=36)group.After overlap weighting,baseline characteristics were balanced.The MMF group demonstrated a significantly lower annualized relapse rate compared to the TAC group[(0.175±0.582)vs.(0.672±1.186)episodes/year,P=0.033]after the first RTX infusion.No statistically significant differences were observed between groups in relapse-free survival,corticosteroid dependency,steroid dose at maintaining relief,minimal steroid dose,minimal steroid maintenance duration,immunosuppressant tapering,or incidence of adverse events(all P＞0.05).Multivariable Cox regression identified body weight as a risk factor for relapse after initial RTX therapy(HR=1.154,95％CI 1.051～1.266,P=0.003)in SDNS children.Conclusion In pediatric patients with steroid-dependent nephrotic syndrome(SDNS)receiving initial rituximab(RTX)therapy,maintenance treatment with mycophenolate mofetil(MMF)is associated with a significantly lower relapse rate compared to tacrolimus(TAC).No statistically significant differences are observed between MMF and TAC in reducing corticosteroid dosage or safety profiles.关键词
儿童/肾病综合征/激素依赖/利妥昔单抗Key words
child/nephrotic syndrome/steroid-dependent/rituximab分类
医药卫生引用本文复制引用
CHEN Liu-tong,CHEN Han,CHEN Ya-li,CHENG Xue-ting,GAN Yue-heng,HAN Xue,WANG Mo,YANG Hai-ping,LI Qiu..利妥昔单抗联合霉酚酸酯或他克莫司在治疗儿童激素依赖型肾病综合征的有效性和安全性评估[J].中国实用儿科杂志,2025,40(11):909-917,9.基金项目
重庆市科卫联合攻关项目(2023GGXM001) （2023GGXM001）
