| 摘要: |
| 目的:总结1 例应用利妥昔单抗治疗难治性激素耐药肾病综合征并导致心律失常患儿的临床特点及诊治经过并进行文
献复习。方法:回顾性分析青岛大学附属妇女儿童医院肾脏免疫科收治的1 例难治性激素耐药肾病综合征患儿的临床诊疗及
随访过程,并以“利妥昔单抗”“心律失常”“rituximab”“arrhythmia”为检索词,检索建库至2023 年5 月中国知网、万方及PubMed
数据库进行文献复习。结果:患儿,男,发病年龄3 岁,肾病综合征病史3 年,无心血管基础疾病。患儿初治激素耐药,他克莫司
敏感但减至小剂量出现频复发及激素依赖,予利妥昔单抗每次100 mg,每周1 次,应用第3 次后患儿出现心律不齐,心电图示窦
性心律不齐、室上性早搏、室上性早搏伴室内差传。之后每月监测心电图或动态心电图,至今随访8 个月,较前无明显变化。文
献复习显示应用利妥昔单抗出现循环系统不良反应发生率5%~8%,包括各种心律失常,如房颤、室性或室上性心动过速、期前
收缩、心动过缓等。在非肿瘤疾病中应用利妥昔单抗治疗后出现心血管不良事件个案报道8 篇文献,加上本例共10 例患者,
(2 例儿童,8 例成人),6 例无心血管疾病史,9 例出现心电图改变,随访仅4 例恢复。结论:随着利妥昔单抗应用范围的扩大,医
师必须意识到该药有致严重的心血管不良反应风险。建议应用利妥昔单抗治疗前后进行心电图、心脏超声监测,以便及时发现
并应对心律失常等心血管不良事件。 |
| 关键词: 利妥昔单抗 肾病综合征 激素耐药 心律失常 |
| DOI：doi:10.13407/j.cnki. jpp.1672-108X.2024.11.009 |
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| 基金项目: |
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| Arrhythmia Induced by Rituximab Treatment for Refractory Steroid-Resistant Nephrotic Syndrome inChildren: a Case Report and Literature Review |
| Zhang Xuan, Cui Guangmei,Ban Hongfang, Xin Dandan, Wang Yibing, Sun Qing |
| (Women and Children’s Hospital
Affiliated to Qingdao University, Shandong Qingdao 266000, China) |
| Abstract: |
| Objective: To summarize the clinical characteristics, diagnosis and treatment of a child with arrhythmia induced by
rituximab treatment for refractory steroid-resistant nephrotic syndrome, and to review the literature. Methods: The clinical diagnosis,
treatment and follow-up process of the child with refractory steroid-resistant nephrotic syndrome admitted into the Department of Renal
Immunization in Women and Children’ s Hospital Affiliated to Qingdao University was retrospectively summarized. “ Rituximab”
“arrhythmia” in Chinese and English were respectively selected from CNKI, Wanfang and PubMed databases up to May 2023, and
literature review was performed. Results: The patient was a 3-year-old male with a 3-year history of nephrotic syndrome and no
underlying cardiovascular disease. After initial treatment, the patient was steroid resistant, tacrolimus sensitive but reduced to a low
dose, which resulted in frequent recurrence and steroid dependence. Rituximab was given 100 mg each time, once a week, and
arrhythmia occurred after the third application. Electrocardiogram showed sinus arrhythmia, supraventricular premature beat, and
supraventricular premature beat with aberrant ventricular conduction. Electrocardiogram or holter electrocardiogram was monitored
monthly and followed up for 8 months, with no significant change compared with before. The incidence of circulatory adverse drug
reactions of rituximab was 5% to 8%, including various arrhythmias, for example atrial fibrillation, supraventricular or ventricular
tachycardia, prephase systole, and bradycardia. Cardiovascular adverse events after rituximab treatment in non-tumor diseases were reported in 8 literature, with a total of 10 patients (including the child in this case), there were 2 children and 8 adults, 6 patients with
no history of cardiovascular disease, 9 patients with electrocardiogram changes, and only 4 patients recovered during follow-up.
Conclusion: With the application expansion of rituximab, clinicians must be aware of the risk of severe cardiovascular adverse events.
It is recommended to perform electrocardiogram and echocardiography monitoring before and after rituximab treatment so as to detect and
treat arrhythmias and other adverse cardiovascular events in time. |
| Key words: rituximab nephrotic syndrome steroid resistance arrhythmia |
