摘要
目的 比较免疫吸附联合生物制剂重组人肿瘤坏死因子受体融合蛋白及生物制剂重组人肿瘤坏死因子受体融合蛋白治疗类风湿关节炎的临床疗效及安全性. 方法 分析2008年1月～2013年6月在北京医院风湿免疫科住院的活动性类风湿关节炎患者共65例,按照治疗方案不同,分为免疫吸附联合生物制剂重组人肿瘤坏死因子受体融合蛋白组（38例）,生物制剂重组人肿瘤坏死因子受体融合蛋白组（27例）,免疫吸附联合组给予免疫吸附治疗,共3次,每次间隔7天,之后给予生物制剂重组人肿瘤坏死因子受体融合蛋白治疗3个月,同时并序贯服用传统缓解病情的抗风湿药（DMARDs）;生物制剂组给予重组人肿瘤坏死因子受体融合蛋白治疗3个月,同时并序贯服用DMARDs,2组患者在性别、年龄、病程及疾病活动度方面无统计学差异.观察治疗前及治疗后4周、24周患者关节疼痛数,关节肿胀数,晨僵时间,血沉,CRP,同时记录患者治疗前后VAS评分,DAS28评分,HAQ评分,患者对疾病总体评价及医生对疾病总体评价,计算两组患者ACR20,50,70缓解率及治疗期间发生的不良反应. 结果 治疗4周后,免疫吸附联合组的关节疼痛数,关节肿胀数,晨僵时间,血沉及CRP的改善与生物制剂组比较,差异有统计学意义（Z=2.733,2.604,2.366,4.137,2.952,P＜0.05）,同样,2组治疗后4周的DAS28评分、HAQ评分比较,差异有统计学意义（Z-4.134,3.262,P＜0.05）;治疗24周后,免疫吸附联合组ACR20,50,70分别为94.7％,92.1％,81.5％,生物制剂组为74.1％,59.3％,44.4％,2组比较差异有统计学意义（x2=4.050,10.077,9.721,P＜0.05）. 结论 免疫吸附联合生物制剂重组人肿瘤坏死因子受体融合蛋白治疗类风湿关节炎起效快,能很快诱导患者疾病缓解,未明显增加不良反应的发生,是活动性类风湿关节炎治疗的一项有益尝试.
Objective To investigate the efficacy and safety of immunoadsorption combined with recombinant human tumor necrosis factor receptor fusion protein for the treatment of active rheumatoid arthritis.Methods We analyzed 65 active rheumatoid arthritis patients in this study.In combined group,38 patients were treated with immunoadsorption combined with recombinant human tumor necrosis factor receptor fusion protein and disease-modifying anti-rheumatic drugs（DMARDs,LEF or MTX）;In biological agent group,27 patients were treated with recombinant human tumor necrosis factor receptor fusion protein and DMARDs（LEF or MTX）.Clinical symptoms and laboratory examination changes were collected before and after treatment for 4 weeks and 24 weeks.Clinical assessments used the American College of Rheumatology criteria（ACR）.Adverse events were evaluated during the treatment.Results All patients completed the treatment.At the treatment for 4 weeks,the improvement of tender joint counts,swollen joint counts,time of morning stiffness,ESR and CRP were greater in combined group than in biological agent group（Z=2.733,2.604,2.366,4.137,2.952,respectively,P〈0.05）,and the improvement of DAS28 and HAQ scores were also greater in combined group than in biological agent group（Z=4.134 and 3.262,respectively,P〈0.05）.At thetreatment for 24 weeks,the rates of ACR20,ACR50,and ACR70 were 94.7%,92.1% and 81.5%,respectively,in combined group,and were 74.1%,59.3% and 44.4%,respectively,in biological agent group（χ2=4.050,10.077 and 9.721,respectively;P〈0.05）.Conclusion Immunoadsorption in combination with recombinant human tumor necrosis factor receptor fusion protein significantly altered the signs and symptoms of rheumatoid arthritis,suggesting that this therapy may be an alternative for the remission induction of rheumatoid arthritis.
出处
《中国血液净化》
2015年第5期289-293,共5页
Chinese Journal of Blood Purification
关键词
类风湿关节炎
免疫吸附
重组人肿瘤坏死因子受体融合蛋白
诱导缓解
Rheumatoid arthritis
Immunoadsorption
Recombinant human tumor necrosis factor re-ceptor fusion protein
Remission induction
