重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白与免疫抑制剂治疗强直性脊柱炎临床观察  

Clinical Observation on Recombinant Human Type Ⅱ Tumor Necrosis Factor Receptor-antibody Fusion Protein and Immunosuppressive Agents in Treatment of Patients with Ankylosing Spondylitis

作　　者：庞琳烜 杨西超[1] 郑朝晖[1] 谢荣华[1] 吴振彪[1] 

机构地区：[1]第四军医大学西京医院临床免疫科,西安710032

出　　处：《解放军医药杂志》2016年第7期92-95,104,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

摘　　要：目的观察重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白与免疫抑制剂治疗强直性脊柱炎(AS)的临床效果。方法回顾性分析2014年1月—2015年2月确诊的AS患者123例的临床资料,按治疗方法分为A、B、C组,每组41例。A组给予注射用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白皮下注射,B组给予依那西普皮下注射,C组给予柳氮磺吡啶口服。观察3组临床疗效及不良反应发生率,分析症状改善时间,记录治疗前后外周关节疼痛评分、肿胀程度评分情况及血红细胞沉降率(ESR)、炎性因子指标改善情况。结果 A、B组治疗总有效率高于C组,治疗12周后3组疼痛评分及外周关节肿胀程度评分均较治疗前降低,ESR和C反应蛋白、肿瘤坏死因子-α、白介素-33、白介素-17水平较治疗前降低,且A、B组低于C组(P<0.05);A、B组下腰背疼痛、外周关节疼痛、外周关节肿胀、晨僵等症状改善时间短于C组,不良反应发生率低于C组(P<0.05)。结论重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白和依那西普则对AS治疗效果优于柳氮磺吡啶,且不良反应较轻,建议综合考虑患者情况,选择最佳用药方案。Objective To observe clinical effect of recombinant human type Ⅱ tumor necrosis factor receptor-antibody fusion protein and immunosuppressive agents in treatment of patients with ankylosing spondylitis （ AS） . Meth-ods Clinical data of 123 AS patients during January 2014 and February 2015 was retrospectively analyzed, and the pa-tients were divided into group A, B and C （ n=41 for each group） according to therapic method. Group A received sub-cutaneous injection of recombinant human typeⅡtumor necrosis factor receptor-antibody fusion protein, and group B re-ceived subcutaneous injection of Etanercept, and group C was treated with Sulfasalazine orally. In 3 groups, clinical cur-ative effects and incidence rates of adverse reactions were observed, and times of symptom improvement were analyzed, and then peripheral joint pain score, score of swelling degree, erythrocyte sedimentation rate （ ESR） and improvement conditions of inflammatory factor indexes before and after treatment were also recorded. Results Total effective rates in group A and B were significantly higher than that in group C. After 12 weeks of treatment, scores of pain and peripheral joint swelling degree decreased, and levels of ESR, c-reactive protein （ CRP） , tumor necrosis factor-α（ TNF-α） , inter-leukin-33 （IL-33） and IL-17 were lower than those before treatment in 3 groups, and the above values in group A and B were lower than those in group C （P〈0. 05）;relief times of symptoms such as lumbar and back pains, peripheral joint pain, peripheral joint swelling, morning stiffness were shorter, and incidence rates of adverse reactions in group A and B were lower than those in group C （P〈0. 05）. Conclusion Recombinant human typeⅡtumor necrosis factor receptor-antibody fusion protein and Etanercept has better effect with milder adverse reactions in treatment of AS patients than that by Sulfasalazine. It is recommended that patient＆#39;s condition should be taken into consideration in choosing which is the b

关 键 词：受体 肿瘤坏死因子 Ⅱ型 免疫抑制剂 脊柱炎 强直性 

分 类 号：R593.23[医药卫生—内科学]