肿瘤坏死因子-α拮抗剂治疗类风湿关节炎并发慢性疾病性贫血疗效研究  

Effects of tumor necrosis factor-α inhibitor and traditional disease modifying anti-rheumatic drugs on anemia in patients with rheumatoid arthritis

作　　者：刘儒曦[1] 杨娉婷[1] 方芳[1] 肖卫国[1] 

机构地区：[1]中国医科大学附属第一医院风湿免疫科,沈阳110001

出　　处：《中国实用内科杂志》2013年第1期49-51,共3页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(30801204);辽宁省科技攻关计划课题(2007225005-6);辽宁省医学高峰建设工程重点科研项目(2009322010006)

摘　　要：目的观察肿瘤坏死因子-α拮抗剂对类风湿关节炎(RA)并发慢性疾病性贫血(ACD)的疗效。方法收集2008年1月至2011年8月中国医科大学附属第一医院风湿免疫科门诊及住院的76例RA伴ACD患者。按照治疗方案的不同分为A、B两组,A组37例,为使用传统缓解病情抗风湿药(DMARDs)3个月以上并同时接受英夫利西单抗治疗的患者;B组39例,为单纯使用传统DMARDs治疗3个月以上的患者。所有患者均随访54周,并于不同观察时点记录相关指标。结果随访54周,A组患者贫血改善者35例,改善率为94.6%,其中30例贫血得到完全纠正,完全纠正率81.1%;B组患者贫血改善率为51.3%,明显低于A组(P<0.01),贫血完全纠正者12例,纠正率为30.8%,明显低于A组(P<0.01)。A组患者12～54周内的最高一次血红蛋白(Hb)质量浓度显著高于B组[(117.2±14.2)g/L对(106.7±13.4)g/L,P<0.01]。A组患者疾病活动指数(DAS28)的降低与Hb质量浓度的增加呈明显正相关关系(r=0.49,P<0.01);而在B组两者之间未呈现明显相关关系(r=0.21,P>0.05)。结论与DMARDs相比,英夫利西单抗可以更迅速、显著地改善RA相关ACD,并且贫血的改善可以作为评价英夫利西单抗有效性的一个敏感预测指标。Objective To compare the efficacy of tumor necrosis factor （TNF） antagonist （infliximab） and traditional dis- ease modifying anti-rheumatic drugs （DMARDs） on anemia of chronic disease （ACD） in patients with rheumatoid arthritis （RA）. Methods We enrolled 76 patients with RA as having concomitant anemia who were admitted to the department of rhenmatology and immunology, First Affiliated Hospital of China Medical University between January 2008 and August 2011. Eligible subjects were assigned to receive a 3-month administration of DMARDs alone （ group A, n = 39） or in combi- nation with izffliximab （ group B, n = 37 ）. Indices at various time points were monitored during a 54-week followed-up peri- od. Results Following a 54-week treatment, group A evidenced a markedly higher proportion of patients （ both P 〈 0. 01 ） achieving improvement （94. 6% ,n =35 vs 51.3% ,n = 19） and complete remission （81.1% ,n =30 vs 30. 8% ,n = 12）. Patients in group A yielded a significantly higher level of culminated hemoglobin than those in group B （ [ 117. 2 ± 14. 2 ] g/ L vs [ 106. 7 ± 13.4 ] g/L,P 〈 0. 01 ） between weeks 12 and 54. The reduction in disease activity score （ DAS28 ） correlated positively with the increase in hemoglobin in group A（r = 0. 49 ,P 〈 0. 01 ）, but not in group B（ r = 0. 21, P 〉 0. 05 ）. Con- clusion Infliximab results in prompt and impressive amelioration in RA-associated ACD as compared with traditional DMARDs. Improvement in anemia may serve as a sensitive surrogate for predicting the efficacy of infliximab.

关 键 词：关节炎 类风湿 贫血 肿瘤坏死因子 

分 类 号：R593.2[医药卫生—内科学]