Динамика аутоантител к топоизомеразе I на фоне лечения ритуксимабом у больных системной склеродермией

Целью исследования было изучение связи между динамикой уровней антинуклеарных факторов (АНФ) и аутоантител к топоизомеразе I (анти-Топо 1) у пациентов с системной склеродермией (ССД) и эффективностью терапии ритуксимабом (РТМ).
Материал и методы. В исследование было включено 88 пациентов (73 женщины) со средним возрастом 47 (17–71) лет. Средняя длительность болезни составила 5,9±4,8 года. Средний период наблюдения превысил 2 года (27 (12–42) мес.).
Результаты. В конце исследования статистически значимо снизились выраженность кожного фиброза и индекс активности заболевания, улучшились показатели легочной функции, была уменьшена суточная доза преднизолона. Статистически значимо уменьшилось число пациентов с высокими титрами АНФ, снизились средние значения титра aнти-Тoпo 1, при этом между АНФ и анти-Топо 1 выявилась умеренная положительная статистически значимая корреляция (r=0,403). В группе пациентов, позитивных по aнтиТoпo 1, снижение индекса активности, увеличение форсированной жизненной емкости и диффузионной способности легких, степень деплеции В-лимфоцитов были статистически значимо более выраженными по сравнению с анти-Топо 1-негативными пациентами.
Заключение. У пациентов с системной склеродермией применение РТМ приводит к снижению титров АНФ и анти-Топо 1, ассоциирующемуся с клинической эффективностью терапии. Можно предположить, что терапия РТМ особенно показана при субтипе ССД, связанном с гиперпродукцией анти-Топо 1.

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