英夫利昔单抗治疗类风湿关节炎疗效预测因素研究  

Clinical prediction of Infliximab for Patients with Rheumatoid Arthritis

作　　者：何伟珍[1] 徐晓东[1] 叶志中[1] 尹志华[1] 李博[1] 郭粉莲[1] 陈芳[1] 黄霞[1] 

机构地区：[1]深圳市第四人民医院香蜜湖风湿病分院广东医学院深圳风湿病研究所,广东深圳518040

出　　处：《现代生物医学进展》2010年第19期3675-3677,共3页Progress in Modern Biomedicine

基　　金：深圳医学重点学科建设资助项目(2005C10);2008年深圳市福田区科技计划项目(FTWS079);2009年深圳市科技计划项目(200903207)

摘　　要：目的:分析应用英夫利昔单抗(INF)治疗的类风湿关节炎(RA)患者的临床和实验等指标,筛选出可预测INF疗效的因素。方法:以应用INF治疗的40例RA患者为研究对象,收集基线和第14周的临床和实验等指标。应用聚合酶链反应一限制性片断长度分析法(PCR-RFLP)检测RA患者的肿瘤坏死因子α-308(TNFα-308)A/G的基因多态性。达到ACR50%-70%改善的的被判断为INF治疗反应好。采用Logistic回归模型筛选出可预测疗效的因素。结果:治疗14周后,携带TNF-308G/G基因型的RA患者,达到ACR20、ACR50、ACR70改善标准的患者人数的百分率分别为93%、64%和30%;A/G基因型,ACR20、ACR50、ACR70的百分率分别为60%、40%和20%。多因素Logistic回归分析显示,基线值中高DAS28评分和携带TNF-308G/G基因型的RA患者,对INF治疗反应好,其OR值分别为1.97(95%CI为1.74-3.13,P<0.01)和2.02(95%CI为1.93-3.91,P<0.01)。结论:高DAS28评分及携带TNF-308G/G基因型的RA患者对INF治疗有更好的应答。RA患者的DAS28评分及携带TNF-308G/G基因型可能可作为INF治疗RA疗效的预测指标。Objective： To analyze the clinical and laboratory datas in rheumatoid arthritis patients treated with infliximab （INF） and to to identify factors predicting good response to INF. Methods： 40 patients with active RA treated with INF therapy were enrolled. The information on demographics, clinical characteristics of patients in baseline and 14 weeks were collected. The polymorphism of the TNF-α-308A/G was detected by PCR-restriction fragment length polymorphism （PCR-RFLP）. Fulfilment of the ACR responsed criteria 50%, 70% （ACR50, ACR70） were judged for good response. Potential predictors of responses were identified using multivariate binary logistic regression models. Results： After 14 weeks, the proportion of patients fulfilling ACR20, ACR50 and ACR70 in the RA patients carrying TNF-308 G / G genotype were respectively 93%, 64% and 30%; A/G genotype, were 60%, 40% and 20%. Multivariate logistic regression analysis showed that high DAS28 in baseline and carrying TNF-308 G/G genotype were significantly associated with good response with odds ratios （ORs） 1.97（95%CI：1.74-3.13, P〈0. 01） and 2.02（95%CI：1.93-3.91, P〈0. 01）, respectively. Conclusion： In this observational study of patients with established RA, high DAS28 score in baseline and carrying TNF-308 G / G genotype were associated with good response, they may serve as a predictor of efficacy.

关 键 词：类风湿关节炎 英夫利昔单抗 LOGISTIC回归 预测因素 

分 类 号：S858.315.3[农业科学—临床兽医学]