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?????????????B???????????????????????1??CD20???????????????棿T???????B?????A. B??? B. T???2??B??????????????????е???????Σ?A. ???????????B. ??RA????е?B???????????????C. ?????????????D. B?????T???????е??????á?3??CD20???????????????????A.????? B.????...

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1??CD20???????????????棿T???????B?????
A. B???        B. T???
2??B???????????????????е???????Σ?
A. ???????????B. ??RA????е?B???????????????C. ??????????????D. B?????T???????е??????á?
3??CD20???????????????????
A.?????        B.?????????
4??CD20?????????????RA???????
?????????RA??????DMARDs??/??TNF-???????????????Ч????????rituximab????
5?????CD20????????????????ü??????????

B????????????????????

    ??????????(rheumatoid arthritis,RA)???????????????????????????????????????RA?????????????????????????1?????й??????в???????????RA????????0.36%??????????????RA????岡???????δ??????????о????????????CD4+T???????????????????????????????????????????????????????????????????-??(TNF-??)??IL??1??IL??6?????????????????????????????????????????????????1?????????????????????????????????

RA?????????????????忹?????NSAIDs???????????????????????(DMARDs)???????Щ???TNF-????IL??1???????????????infliximab??etanercept??adalimumab??anakinra??????????????RA??????y?????Ч?????????????????????????Щ??????Ч?????????????????????????Ч??????Ρ?

1?? ??CD20?????????????RA?????????

    B?????RA????????????е??????????????м????棺??1?????????????????????????????????CD4+T ???????????????????2????RA????е?B?????????TNF-????????????????????????3????????????????RF??????RF???????????????????????????????RF???????????B????????Th?????????????????4??????T?????RA?????з?????????B?????T?????????????????????á???Щ???B???????????????RA?????????????á???????????????????B??????????RA????????????????
    Rituximab(?????Rituxan??MobThera)???????CD20????????塣CD20???????pre-B?????B???????????????????в??????????????????????Rituximab????B?????????????????????????1??????????????鵼????????á?????????????????????????????????Fc???????????CD20????????CD20+B????????2??????鵼????????á?Rituximab?????CD20?????????C1q?????????????????????????????CD20+B????????3??????rituximab??????CD20??B??????????????Щ?????rituximab??????CD20+B????????????????????????6???£??????9-12?????????B????????????????????
    Rituximab?????類???????????CD20+B?????????????????塣??????????г???30??????????????rituximab?????????????????????????????RA??????????????rituximab??????鷢??????????????????????rituximab????B??????????????????RA.

2?? Rituximab????RA??????о?

    ???Edwards JC ?????????rituximab????RA??С???????????о???????5??RA??????????5??DMARDsЧ????????Rituximab???????????2??300mg????8??15??22??????600mg????????????????????30~60mg/d ????22d???????4????17?????農?????750mg????????????????76?????????????5??????????????????????????????????????6??????л??????ACR50????????3????ACR70??????2????????34????49???????????rituximab?????ACR70????????5???????????????????????????????????????????????5????????Ч???????????м??????rituximab?????????RA????????о???Leandro????о????rituximab?????³600mg/m2???????????????????RA??????Ч??De Vita S[11]???о????????rituximab???Щ?????RA???????Ч?????????C???????????RF????Moore[12]???о?????????????????????????RA????????rituximab???Ч??????????Щ?о????????????????С?????о????????????????????????????NASIDs??/????????????????????????????????????????????????????rituximab??RA????Ч?????????

    ????????????????о??У?161???侭?????????????????RA??????????4?飺??1????????????饗³10mg/???????2??rituximab?饗??1???15?????????1000mg??????3??rituximab???????????????3????17??????750mg??????4??rituximab???ü?????????24???ACR50?????????rituximab???ü??????饗43??????rituximab????????????饗41?????????????????rituximab?饗33????????????饗13?????????48????????????黼??ACR50??????????????????????顣???????????????rituximab????????RF??????????24????????????????ü???????RF????????????????

    2006?????????DANCER?о???dose??ranging assessment??international clinical evaluation of rituximab in rheumatoid arthritis???????IIb???????ο?????????飬??465??????????????????1??DMARDs??/??TNF-???????????Ч????????RA????μ????????????????rituximab???????Ч?????????????    ??rituximab??Ч????????????Rituximab?÷?????1????15??????????ο??????rituximab500mg????rituximab1000mg???????????÷????1????15?????rituximab??30~60min?????????ο??????100mg??????????????100mg???????????????2~7?????????60mg????8~14???????????30mg???????9?飬??????????rituximab 1???÷???????????1???÷??????л???????????????(10~25mg/??)????????????????????24??ACR20???????rituximab 500mg?饗55??????rituximab 1000mg?饗54???????????ο???饗28??????ACR50????????2?饗????35????34????????????ο???饗13??????ACR70????????2?????13????20??????????ο???饗5??????????????2??RA??????DAS28??EULAR????????????rituximab2???????????δ??rituximab????????????RA???????????о???????rituximab???????????δ??rituximab??????????????????????????????????24???ACR20????????????????????????rituximab??????????????DANCER???о?????????RA,????????????2????????rituximab???????Ч?????о?????????????????????rituximab??Ч????????????rituximab????????
    Rituximab??????????????????????????????????????????????????30~120min????????????????η?????????????????????????????????rituximab???????????????о??з??????????????з???????70??~80????????????з????????????????????????????????????????????RA?????У?rituximab?????????????????????????DANCER?о??У?rituximab 500mg??1000mg?鼱????????????23????32??????ο???17???????ü?????rituximab 500mg??1000mg????ο???鼱????????????32????37????14????????ü?????????鼱?????????????19????29????19????????????輤??????????????rituximab??????????[13]??
    ??????????Щ?о????????????????????FDA??????????У???????RA????????1???????TNF-???????????Ч??????????rituximab????????RA?????????DMARDs??TNF-?????????????????????????Ч????????Ρ?
    Rituximab????RA????????????????????????2?????1000mg???????????????????50mg/h?????????????????????????????????????????400mg/h????????????農????????????????????????100mg???????????????????rituximab????ü??????
    ?????????Щ?????о?????rituximab???????Щ?????????????????????????????????????ANCA?????????????????????á??????????????????????????????????????????????о???
3?? ???
    B?????RA??????????????á??????CD20?????????rituximab????????B???????????RA,?????????????о?????Rituximab?????RA?????????????????????????B?????????????????????????????????RA???????????Rituximab????RA?????????????Ч????????????RA??????DMARDs??/??TNF-???????????????Ч????????rituximab?????

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