双重滤过血浆置换治疗难治性类风湿关节炎的疗效观察  

Effect of double filtration plasmapheresis in refractory rheumatoid arthritis

作　　者：于笑霞[1] 平利峰[1] 刘俊兰[1] 孙凤艳[1] 王园园[1] 卢伟伟[1] 姜淑华[1] 田俊阁[1] 

机构地区：[1]河北省沧州中西医结合医院风湿免疫科,河北省沧州市061001

出　　处：《中国综合临床》2008年第12期1222-1225,共4页Clinical Medicine of China

基　　金：河北省优秀专家出国培训基金资助项目（200447）;河北省重点科技攻关项目（60543）

摘　　要：目的探讨双重滤过血浆置换（DFPP）治疗难治性类风湿关节炎（RA）的临床疗效。方法经两或三种改善病情的抗风湿药（DMARDs）规范治疗3～6月以上、病情不能缓解的活动性RA患者82例，随机分为DFPP组42例和非DFPP组40例。均给予柳氮磺胺吡啶＋甲氨蝶呤治疗；DFPP组在此治疗的基础上予以DFPP治疗。随访12～24个月。DFPP治疗结束后次日及随访结束时进行评估，通过疾病活动指标及类风湿因子、功能评估（HAQ）及美国风湿病学会推荐RA病情改善ACR标准判断临床疗效。结果①DFPP组ACR20、ACR50和ACR70分别为100％、92．9％和81．0％，明显高于非DFPP组（17．5％、0、0，P〈0．001），并于随访1～24个月后保持不变。②DFPP组功能评估明显改善，非DFPP组无变化，两组相比差异有统计学意义（P〈0．001）。③DFPP组疾病活动指标、类风湿因子明显下降，变化显著高于非DFPP组（P〈0．001）。结论DFPP可迅速控制难治性RA患者的病情，明显改善功能，提高生活质量，临床疗效显著。Objective To evaluate the efficacy of double filtration plasmapheresis （DFPP） in the treatment of patients with refractory rheumatoid arthritis （RA）. Methods Eighty-two patients were randomly assigned,42 to the DFPP group and 40 to the no-DFPP group. All patients previously experienced an incomplete response to 2-3 dis- ease-modifying antirheumatic drugs （DMARDs） and 1-2 nonsteroidal anti-inflammatory drugs （ NSAIDs ） or predni- sone. All patients received sulphasalazine （SASP,0.75 g three times daily） plus methotrexate（ MTX, 10 mg orally once weekly ）. DFPP was performed once a week for 2-3 sessions. A total of 121 plasmapheresis procedures were performed in 42 patients. Control patients did not receive sham DFPP. The efficacy measures recorded one day after the final treatment and latest month in follow up for 12 - 24 months included the American College of Rheumatology 20% ,50% ,and 70% improvement criteria （ACR20, ACR50, and ACR70）, the Health Assessment Questionnaire estimate of disability （ HAQ ） ; and the disease activity index. Results Patients in the DFPP group had ACR 20, ACR 50 and ACR 70 improvements of 100% ,92.9% and 81.0% ,as compared with the patients in no-DFPP group 17.5% ,0,and 0 （ P 〈0.001 ）. Significant change from baseline was observed in HAQ scores in the DFPP group but not in the no-DFPP group （ P 〈 0.001 ）. The changes from baseline in the disease activity scores were significantlygreater than in the no-DFPP group （ P 〈 0.001 ）. Conclusion DFPP therapy significantly alters the signs and symptoms of refractory RA. There are significant increases in physical function and improvement in quality of life.

关 键 词：类风湿关节炎 双重滤过血浆置换 

分 类 号：R593.22[医药卫生—内科学]