文章摘要
李平方,徐小刚,刘 恒,谭小猛,刘 佩,李占亭.糖皮质激素联合利妥昔单抗对特发性膜性肾病患者血脂、Th17/Treg失衡和血清PLA2R抗体、THSD7A抗体的影响[J].,2023,(24):4771-4775
糖皮质激素联合利妥昔单抗对特发性膜性肾病患者血脂、Th17/Treg失衡和血清PLA2R抗体、THSD7A抗体的影响
Effects of Glucocorticoid Combined with Rituximab on Blood Lipids, Th17/Treg Imbalance, Serum PLA2R Antibody and THSD7A Antibody in Patients with Idiopathic Membranous Nephropathy
投稿时间:2023-06-07  修订日期:2023-06-30
DOI:10.13241/j.cnki.pmb.2023.24.034
中文关键词: 糖皮质激素  利妥昔单抗  特发性膜性肾病  血脂  Th17/Treg失衡  PLA2R抗体  THSD7A抗体
英文关键词: Glucocorticoid  Rituximab  Idiopathic membranous nephropathy  Blood lipids  Th17/Treg imbalance  PLA2R antibody  THSD7A antibody
基金项目:陕西省自然科学基础研究计划项目(2019JM-033)
作者单位E-mail
李平方 空军军医大学唐都医院肾脏内科 陕西 西安 710038 13891814171@163.com 
徐小刚 西安市国际医学中心医院肾脏内科 陕西 西安 710117  
刘 恒 西安市国际医学中心医院肾脏内科 陕西 西安 710117  
谭小猛 西安市国际医学中心医院肾脏内科 陕西 西安 710117  
刘 佩 西安市国际医学中心医院肾脏内科 陕西 西安 710117  
李占亭 西安市国际医学中心医院肾脏内科 陕西 西安 710117  
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中文摘要:
      摘要 目的:探讨糖皮质激素联合利妥昔单抗对特发性膜性肾病(IMN)患者血脂、辅助性T细胞17(Th17)/调节性T细胞(Treg)失衡和血清抗磷脂酶A2受体(PLA2R)抗体、抗I型血小板反应蛋白7A域(THSD7A)抗体的影响。方法:收集空军军医大学唐都医院2022年3月~2023年3月期间收治的IMN患者112例。根据随机数字表法将入组患者分为对照组(56例,糖皮质激素治疗)与治疗组(56例,对照组的基础上接受利妥昔单抗治疗)。观察两组疗效、血脂[低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)]、肾功能[胱抑素C(CysC)、血肌酐(Scr)、血尿素氮(BUN)、24 h尿蛋白定量]、Th17/Treg相关指标[Th17细胞百分比、白细胞介素-17(IL-17)、Treg细胞百分比、转化生长因子β1(TGF-β1)、肿瘤坏死因子-α(TNF-α)]和血清PLA2R抗体、THSD7A抗体水平变化情况,并观察两组治疗安全性。结果:与对照组相比,治疗组的临床总有效率更高(P<0.05)。与对照组相比,治疗组治疗6个月后TC、TG、LDL-C、CysC、Scr、BUN、24 h尿蛋白定量、Th17、IL-17、TNF-α、PLA2R抗体、THSD7A抗体更低,HDL-C、Treg、TGF-β1更高(P<0.05)。两组不良反应发生率对比未见差异(P>0.05)。结论:糖皮质激素联合利妥昔单抗应用于IMN患者,可有效改善患者血脂、Th17/Treg失衡和血清PLA2R抗体、THSD7A抗体水平,且不增加不良反应发生率,具有较好的临床应用价值。
英文摘要:
      ABSTRACT Objective: To investigate the effects of glucocorticoid combined with rituximab on blood lipids, helper T cell 17 (Th17)/regulatory T cell (Treg) imbalance, serum anti-phospholipase A2 receptor (PLA2R) antibody and anti-type I thrombospondin 7A domain (THSD7A) antibody in patients with idiopathic membranous nephropathy (IMN). Methods: 112 IMN patients who were admitted to Tangdu Hospital of Air Force Military Medical University from March of 2022 to March 2023 were collected. Enrolled patients were divided into control group (56 cases, glucocorticoid treatment) and treatment group (56 cases, rituximab treatment on the basis of control group) according to the random number table method. The efficacy, blood lipids [low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglyceride (TG)], renal function [cystatin C (CysC), serum creatinine (Scr), blood urea nitrogen (BUN), 24 hour urine total protein quanti-fication], Th17/Treg related indicators [Th17 cell percentage, interleukin-17 (IL-17), Treg cell percentage, transforming growth factor β1 (TGF-β1), tumor necrosis factor-α (TNF-α)], serum PLA2R antibody and THSD7A antibody levels were observed in two groups, and the safety in two groups was observed. Results: Compared with control group, the total clinical effective rate in treatment group was higher(P<0.05). Compared with control group, TC, TG, LDL-C, CysC, Scr, BUN, 24 hour urine total protein quanti-fication, Th17, IL-17, TNF-α, PLA2R antibody, THSD7A antibody were lower in treatment group 6 months after treatment, and HDL-C, Treg and TGF-β1 were higher (P<0.05). There was no difference in the incidence of adverse reactions between two groups (P>0.05). Conclusion: Glucocorticoid combined with rituximab in patients with IMN can effectively improve blood lipids, Th17 / Treg imbalance, serum PLA2R antibody and THSD7A antibody levels, without increasing the incidence of adverse reactions, and has good clinical application value.
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