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. (Chinese)

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). 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. 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). 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. [ABSTRACT FROM AUTHOR]

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 茁1（TGF-茁1）、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-茁1 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。 [ABSTRACT FROM AUTHOR]

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