We retrospectively analyzed therapy efficacy and the adverse reactions of 10 patients suffering from systemic lupus erythematosus (SLE) with intestinal involvement treated with rituximab (RTX). Patients were hospitalized in the Department of Rheumatology and Immunology of the First Medical Center of PLA General Hospital from January 2015 to January 2023. Among the 10 patients, two were men and eight were women. The age of the cohort was (41.9±8.8) years. The age at disease onset was (28.8±9.2) years. The total course of the SLE diagnosis was(109.6±59.9) months. The course of the diagnosis of SLE with intestinal involvement was (89.3±50.2) months. The time from the appearance of intestinal symptoms to the diagnosis of SLE with intestinal involvement was 1.5 (1.0,8.0) months. The time from the diagnosis of SLE with intestinal involvement to RTX use was 13.0 (1.0,46.3) months. Follow-up duration after application of RTX treatment was (55.3±28.4) months. There were five cases of abdominal pain, four cases of abdominal distension, nine cases of diarrhea, three cases of nervous-system involvement, nine cases of lupus nephritis, and seven cases of serositis. All 10 patients underwent computed tomography and radiology of the abdomen. Eight patients had intestinal-wall edema, seven suffered intestinal dilation, four had target signs, three suffered congestion of mesenteric blood vessels, eight had increased mesenteric-fat density, and six had false intestinal obstruction. All 10 patients showed a low level of complement C3 (250-750 mg/L). Nine cases showed a low level of complement C4 (10-90 mg/L). The SLE disease activity index 2000 (SLEDAI-2K) at baseline in 10 patients was 20.5 (17.8, 30.0). After receiving RTX (0.5 g: day 1, day 14, or 375 mg/m2: day 1, day 14) induction treatment, the intestinal symptoms of 10 cases were relieved completely. Four patients had adverse reactions, of which three received a high-dose glucocorticoid combined with RTX treatment simultaneously. Adverse reactions manifested mainly as a reduced level of IgG and infection with herpes simplex virus in one case, reduced level of IgG and lung infection in one patient, lung infection in one case, and reduced IgG level in one patient. RTX may an efficacious treatment strategy for patients suffering from refractory SLE with intestinal involvement.
回顾性分析2015年1月至2023年1月在解放军总医院第一医学中心风湿免疫科住院治疗的10例接受利妥昔单抗（RTX）治疗的系统性红斑狼疮（SLE）肠道受累患者的疗效和不良反应。10例患者中，男2例，女8例，年龄（41.9±8.8）岁，发病年龄（28.8±9.2）岁，诊断SLE的总病程为（109.6±59.9）个月，诊断SLE肠道受累的病程为（89.3±50.2）个月，出现肠道症状至明确诊断SLE肠道受累的时间为1.5（1.0，8.0）个月，诊断SLE肠道受累至使用RTX的时间为13.0（1.0，46.3）个月，应用RTX治疗后随访时间（55.3±28.4）个月。10例患者中，腹痛5例，腹胀4例，腹泻9例，神经系统受累3例，狼疮肾炎9例，浆膜炎7例。10例患者均行腹部CT、腹部X线平片检查，表现为肠壁水肿8例，肠管扩张7例，靶征4例，肠系膜血管充血3例，肠系膜脂肪密度增加8例，假性肠梗阻6例。低补体C3者10例（补体C3 250~750 mg/L）；低补体C4者9例（补体C4 10~90 mg/L）。10例患者SLE疾病活动性指数2000（SLEDAI-2K）基线期为20.5（17.8，30.0）。10例患者接受RTX（0.5 g，第1天、第14天，或375 mg/m2，第1天、第14天）诱导治疗后，肠道症状完全缓解。4例患者发生不良反应，其中3例同时接受了大剂量糖皮质激素冲击联合RTX治疗，不良反应主要表现为1例IgG减低和单纯疱疹病毒感染，1例IgG减低和肺部感染，1例肺部感染，1例IgG减低。对难治性SLE肠道受累者，RTX可能是有效治疗策略之一。.