不同类型TNF拮抗剂治疗强直性脊柱炎发生不良反应的临床分析  

Clinical analysis of adverse reactions of ankylosing spondylitis patients treated by different TNF-inhibitors

作　　者：周兰兰[1] 丁玉[1] 

机构地区：[1]南京医科大学第一附属医院风湿免疫科,南京210029

出　　处：《上海交通大学学报（医学版）》2013年第12期1620-1624,共5页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的观察采用不同结构和人源化程度的肿瘤坏死因子(TNF)拮抗剂治疗强直性脊柱炎过程中不良反应的发生情况。方法收集接受TNF拮抗剂治疗的180例强直性脊柱炎患者的资料,了解不同生物结果 TNF拮抗剂的分布,观察患者不良反应的发生和治疗情况。结果分别选用3种不同结构和人源化程度的TNF拮抗剂进行治疗,其中50例患者使用英夫利昔单抗(人鼠嵌合单抗,静脉给药),50例患者使用阿达木单抗(全人源化单抗,皮下注射),80例患者使用依那西普(进口和国产,均为皮下注射)。3种TNF拮抗剂治疗过程中均有不良反应发生,英夫利昔单抗、依那西普(国产)、依那西普(进口)和阿达木单抗不良反应的发生率分别为14%、13%、4%、6%;全人源化TNF拮抗剂总体安全性优于人鼠嵌合的TNF拮抗剂。结论相较于全人源化TNF拮抗剂,人鼠嵌合抗体更易诱发不良反应,可能与其免疫原性有关,在使用中必须严格观察和处理。Objective To study immunologic mechanisms induced by different TNF-inhibitors in ankylosing spondylitis treatment. Methods A total of 180 patients with ankylosing spondylitis received TNFc~ inhibitors were collected. Distribution of different TNF-inhibitors and adverse reactions of patients were observed. Results Three kinds of TNF- inhibitors were used. Among the patients, 50 were treated with Infliximab; 50, with Adalimumab; and 80, with Etanercept. The adverse reaction rates were 14%, 13%, 4%, and 6% in Infliximab, Etanercept （ domestic）, Etanercept （imported）, and Adalimumab, respectively. The humanized TNF-inhibitor was safer than the human-mouse chimeric TNF- inhibitor. Conclusion The human-mouse chimeric TNF-inhibitor was more likely to induce adverse reactions, which might be related to its immunogenieity.

关 键 词：肿瘤坏死因子拮抗剂 强直性脊柱炎 不良反应 

分 类 号：R593.23[医药卫生—内科学]