BOLALARDA STEROID-SEZGIR NEFROTIK SINDROMNI DAVOLASHDA MONOKLONAL ANTITANALARNI QO‘LLASH
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Nefrotik sindrom, rituksimab, steroidga sezgir nefrotik sindrom, B-limfotsitlar deplesiyasi, immunosupressiya, CD20##article.abstract##
Kirish. Nefrotik sindrom (NS) bolalarda eng keng tarqalgan glomerulyar kasalliklardan biri hisoblanadi. Kortikosteroidlar dastlabki epizodni davolashda asosiy o'rin tutishiga qaramay, bemorlarning taxminan 50% ida kasallik tez-tez qaytalanuvchi yoki steroidga bog'liq shaklga o'tadi. An'anaviy immunosupressiv terapiyaga chidamli holatlarda rituksimab - CD20 ga qarshi ximerik monoklonal antitelo - istiqbolli terapevtik variant sifatida ko'rib chiqilmoqda.
Maqsad. Bolalarda steroidga sezgir nefrotik sindromda rituksimabning barqaror remissiyaga erishishdagi samaradorligini baholash va qulay davolash natijalarining klinik prediktorlarini aniqlash.
Metodlar. Prospektiv tadqiqotga 2021–2025 yillarda Milliy bolalar tibbiyot markazida davolangan, birlamchi NS tashxisi qo'yilgan 85 nafar bola kiritildi. Barcha bemorlar 14 kun oralig'ida ikki marta rituksimab (750 mg/m²) infuziyasi oldi; remissiya saqlanib qolgan holatlarda har 6 oyda takroriy infuziyalar o'tkazildi (jami 3 kurs). Statistik tahlilda uzluksiz o'zgaruvchilar uchun Mann–Whitney U mezoni, kategorik ma'lumotlar uchun esa shanslar nisbati (ShN) hisobi bilan Fisher aniq mezoni qo'llanildi.
Natijalar. Barqaror remissiyaga 68 nafar bemorda (80%) erishildi; davolanishdan keyin qaytalanish 33 nafar bolada (38,8%) kuzatildi. Remissiyaning statistik jihatdan sezilarli prediktorlari quyidagilar bo'ldi: kasallikning boshlanishida kattaroq yosh (5,07 va 3,49 yil; p=0,023), rituksimab yuborilgan paytdagi kattaroq yosh (11,57 va 8,90 yil; p=0,013) va davolashdan oldingi past qaytalanish chastotasi (p=0,010). Rituksimabdan keyin immunosupressiv terapiyani davom ettirish remissiyaning past imkoniyati bilan bog'liqligi aniqlandi (ON=0,172; 95% DI: 0,053–0,560; p=0,004), bu ko'rsatkich bo'yicha chalkashlik bilan izohlanadi. Jins, biopsiya topilmalari va davolanishdan oldingi kasallik davomiyligi muhim prediktorlar bo'lmadi. Jiddiy nojo'ya ta'sirlar qayd etilmadi; infuziya paytidagi engil reaksiyalar bemorlarning 7,1% da kuzatildi.
Xulosa. Rituksimab bolalarda steroidga sezgir nefrotik sindromni davolashda yuqori samarali va yaxshi tolerant preparat bo'lib, har 6 oyda qayta yuborish protokoli bilan bemorlarning 80% ida uzoq muddatli remissiyaga erishishni ta'minlaydi. Kasallikning kech boshlanishi, birinchi infuziya paytidagi kattaroq yosh va davolashdan oldingi past qaytalanish chastotasi qulay prognoz bilan bog'liq. Dozalash rejimlarini va qayta davolash oraliqlarini optimallashtirishga oid istiqbolli tadqiqotlar o'tkazish zarur.
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