我国类风湿关节炎患者应用肿瘤坏死因子抑制剂现况调查  

Survey of tumor necrosis factor inhibitors application in patients with rheumatoid arthritis in China

作　　者：王秀茹[1,2] 苏茵[1] 安媛[1] 周云杉[1] 张晓盈[1] 段天骄[1] 朱佳鑫[1] 李小峰[3] 王彩虹[3] 王莉枝[3] 王永福[4] 杨荣[4] 王国春[5] 卢昕[5] 朱平[6] 陈丽娜[6] 王轶[7] 王晓元[7] 靳洪涛[8] 刘金婷[8] 陈海英[9] 魏平[9] 王俊祥[9] 刘湘源[10] 孙琳[10] 崔刘福[11] 舒荣[11] 刘白鹭[11] 张卓莉[12] 李光韬[12] 李振彬[13] 杨静[13] 李俊芳[14] 贾彬[14] 张风肖[15] 陶杰梅[15] 林金盈[16] 韦美秋[16] 刘晓敏[17] 柯丹[17] 胡绍先[18] 叶丛[18] 韩淑玲[19] 杨岫岩[20] 李昊[20] 黄慈波[21] 高明[21] 赖蓓[21] 李兴福[22] 宋立军[22] 穆荣[1] 栗占国[1] 

机构地区：[1]北京大学人民医院风湿免疫科,北京100044 [2]北京大学首钢医院多顶街社区卫生中心全科 [3]山西医科大学第二医院风湿免疫科,太原030001 [4]包头医学院第一附属医院风湿免疫科,包头014010 [5]中日友好医院风湿免疫科,北京100029 [6]第四军医大学西京医院风湿免疫科,西安710032 [7]兰州大学第二医院风湿免疫科,兰州730030 [8]河北医科大学第二医院风湿免疫科,石家庄050000 [9]河北医科大学第三医院风湿免疫科,石家庄050051 [10]北京大学第三医院风湿免疫科,北京100191 [11]华北煤炭医学院附属开滦医院风湿免疫科,唐山063000 [12]北京大学第一医院风湿免疫科,北京100034 [13]白求恩国际和平医院风湿免疫科,石家庄050082 [14]河北邯郸中心医院风湿免疫科,邯郸056001 [15]河北省人民医院风湿免疫科,石家庄050051 [16]广西壮族自治区人民医院风湿免疫科,南宁530021 [17]北京顺义区医院风湿免疫科,北京101300 [18]华中科技大学同济医学院附属同济医院风湿免疫科,武汉430030 [19]北京大学首钢医院风湿免疫科,北京100144 [20]中山医科大学附属第一医院风湿免疫科,广州510080 [21]北京医院风湿免疫科,北京100730 [22]山东大学齐鲁医院风湿免疫科,济南250012

出　　处：《北京大学学报（医学版）》2012年第2期182-187,共6页Journal of Peking University:Health Sciences

基　　金：“十一五”国家科技支撑计划项目(2008BAI59B01)资助~~

摘　　要：目的:了解我国类风湿关节炎(rheumatoid arthritis,RA)患者应用肿瘤坏死因子(tumor necrosis factor,TNF)抑制剂的现状以及影响其应用的因素。方法:采用多中心现况调查问卷调查的方法,记录入选者的一般情况和应用TNF抑制剂的情况,计算患者应用TNF抑制剂的费用,分析我国TNF抑制剂的应用现状及影响其应用的相关因素。结果:2009年7月至2010年11月期间,共有全国范围内的21家大型医院风湿免疫科就诊的1 095位RA患者完成问卷,其中112位患者应用了TNF抑制剂(infliximab,商品名类克或etanercept,商品名益赛普)进行治疗,占总研究人群的10.2%(其中益赛普81例,占7.4%;类克26例,占2.4%;两种制剂都用过者5例,占0.5%)。应用类克疗程<3个月及3～6个月者均为38.1%,益赛普疗程<3个月及3～6个月者分别占38.5%和25.0%。应用类克疗程<3个月、3～6个月及6～9个月者的健康评估问卷(health assessment question-naire,HAQ)评分分别为1.1、0.5、0.1,益赛普的相应评分分别为1.3、1.0、0.3。应用类克疗程<3个月、3～6个月及6～9个月的费用分别为24 525.0、69 300.0、96 800.0元,益赛普的费用分别为7 394.8、9 158.6、54 910.9元。应用类克疗程<3个月、3～6个月及6～9个月的患者的间接经济损失分别为365.6、0、158.9元,益赛普分别为2 158.4、288.5、180.1元。出现过敏和感染的比例在应用益赛普者均为3.5%,在应用类克者均为6.5%。Logistic回归分析显示,受教育程度是影响TNF抑制剂应用的主要相关因素。结论:在我国大型医院就诊的RA患者中约有10%应用过TNF抑制剂,其病情随应用TNF抑制剂的疗程延长而减轻,治疗总费用随用药疗程延长而增加,但间接经济损失随疗程延长而减少,主要不良反应为过敏和感染,受教育程度是影响其应用的主要相关因素。Objective：To investigate the current status of tumor necrosis factor（TNF） inhibitors application in rheumatoid arthritis（RA） patients in China and to analyze the related factors.Methods： A retrospective survey was conducted in 21 hospitals from different parts of China.The patients with RA were randomly enrolled.Data of their social backgrounds,clinical conditions,usage and adverse effects of TNF inhibitors were collected.The costs of TNF inhibitors and the indirect costs of the disease were calculated.A multivariate Logistic regression analysis was performed to analyze the factors related to TNF inhibitors application.Results： In the study,1 095 RA patients from July 2009 to November 2010 were enrolled,of whom 112 had received TNF inhibitors,representing 10.2% of the total patients.The patients who received etanercept and infliximab were 7.4%（86/1 095） of the patients and 2.4%（26/1 095）,respectively.There were 0.5% of the patients（5/1 095） who had received both of the TNF inhibitors.The patients who had accepted etanercept and treatment duration for less than 3 months and 3-6 months accounted for 38.5% and 25.0% respectively,while those treated with Infliximab were 38.1%.Their health assessment question-naire（HAQ） scores were 1.1,0.5 and 0.1,corresponding to treatment duration of infliximab for less than 3,3-6 and 6-9 months and those were 1.3,1.0,0.3 corresponding to treatment duration of etanercept,respectively.Infliximab costs were RMB 24 525.0,69 300.0 and 96 800.0 Yuan and etanercept costs were RMB 7 394.8,9 158.6,54 910.9 Yuan,respectively.Indirect costs for RA patients who accepted infliximab for less than 3,3-6 and 6-9 months were RMB 365.6,0 and 158.9 Yuan and those who accepted etanercept were RMB 2 158.4,288.5 and 180.1 Yuan,respectively.Allergy and infection were the main side-effects of etanercept and both happened in 3.5% of all the patients.Liver damage happened in 2.3% of all the patients,while allergy and infection happened in 6.5% of all the patients who accepted i

关 键 词：关节炎 类风湿 肿瘤坏死因子 问卷调查 药费支出 

分 类 号：R593.22[医药卫生—内科学]