托珠单抗治疗全身型幼年特发性关节炎24例疗效分析  

Efficacy of Tocilizumab in the treatment of systemic juvenile idiopathic arthritis

作　　者：段炤[1] 林智平[2] 徐琨[1] 邓宇虹[1] 彭宇[1] 李琳[1] 邹峥[1] Duan Zhao;Lin Zhiping;Xu Kun;Deng Yuhong;Peng Yu;Li Lin;Zou Zheng(Department of Rheumatology and Immunity, Jiangxi Provincial Children＇s Hospital, Nanchang 330006, Chin;Department of Gastroenterology, the Second Hospital of Nanchang , Nanchang 330003, Chin)

机构地区：[1]江西省儿童医院风湿免疫科,330006 [2]南昌市第二医院消化科,330003

出　　处：《中华实用儿科临床杂志》2017年第21期1632-1635,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨托珠单抗注射液（雅美罗）治疗全身型幼年特发性关节炎（sJIA）的临床疗效及安全性。方法选取2015年10月至2016年5月在江西省儿童医院风湿免疫科住院的sJIA患儿24例，sJIA患儿均接受托珠单抗注射液＋甲氨蝶呤治疗，观察治疗前、治疗后第4、8、12周血常规、肝功能、肾功能、活动性关节炎的关节数目、活动受限的关节数目、医师及患儿对疾病总体评价、健康问卷调查、红细胞沉降率（ESR）、C反应蛋白（cRP）及美国风湿病学会儿科标准（AcRPed）30、50、70达标率等各项观察指标的变化，并记录不良反应发生情况。结果sJIA患儿托珠单抗注射液联合甲氨蝶呤治疗后第4周与治疗前比较，白细胞计数[（15．1±2．7）×10^9／L比（24．2±3．5）×10^9／L]显著下降，血红蛋白[（110±12）g/L比（98±10）g／L]显著上升，血小板[（277±73）×10^9／L比（368±62）×10^9／L]显著下降，差异均有统计学意义（t=10．08、-3．76、4．65，均P〈0．05）；治疗后第8、12周与治疗后第4周比较无明显变化。治疗后第4周EsR较治疗前[（25±12）mIn／1h比（75±15）mIn／1h]、cRP[（20±13）mg/L比（64±18）mg/L]均下降，差异均有统计学意义（t=70．71、26．78，均P〈0．05）；治疗后第8、12周下降更显著（均P〈0．05）。治疗后第4周AcRPed30、50、70达标率分别为82％、74％、68％，第8周为90％、82％、78％，第12周为98％、93％、92％，达标率持续改善，差异均有统计学意义（F=7．11、7．29、8．86，均P〈0．05）。治疗后第12周患儿血清IL-6水平为（10．8±2．5）ng／L，与治疗前[（12．7±3．0）ng/L]比较差异无统计学意义（t=1．96，（P〉0．05）。结论托珠单抗注射液治疗sJIA效果显著，能在短期内改善sJIA的各项症状、体征及实验室炎性活动指标，且安全性好。Objective To explore the efficacy and safety of Tocilizumab in the treatment of systemic juvenile idiopathic arthritis （sJIA） in children. Methods Twenty - four sJIA patients were collected who were hospitalized at the Department of Rheumatology and Immunity, Jiangxi Provincial Children＇s Hospital from October 2015 to May 2016, and they received Tocilizumab combined with Methotrexate（MTX） treatment for 12 weeks. The clinical laboratory and physiological indices, including routine blood, liver and kidney function tests, number of joints with active arthritis, number of joints with limited range of motion, physicians and patients assessment of disease activity, childhood health questionnaire, erythrocyte sedimentation rate （ ESR）, C - reactive protein （ CRP ）, and compliance rates of Pediatrics of American College of Rheumatology （ ACR Ped） 30,50,70 were observed after 4,8 and 12 weeks of treatment, and the adverse reactions were recorded. Results After 4 weeks of treatment,the levels of white blood cells,platelet, ESR and CRP in 24 cases of sJIA significantly decreased compared with those of the patients before treatment [ （15.1± 2.7 ） × 10^9/L vs. （24.2 ＋3.5） × 10^9/L, （277 ±73） × 10^9/L vs. （368 ±62） × 10^9/L, （25 ＋ 12） mm/1 h vs. （75 ± 15） mm/1 h, （20 ± 13 ） mg/L vs. （64 ± 1 ） mg/L], and the differences were statistically significant （ t = 10.08,4.65, 70.71,26.78 ,all P 〈0.05） ;the hemoglobin was inereased dramatieally[ （ 110 ± 12） g/L vs. （98 ± 10） g/L] ,and the differenee was statistically significant（ t = -3.76, P 〈 0.05 ）. The eompliance rates of ACR Ped 30,50,70 after 4 weeks of treatment were 82% , 74% , 68% , and they were continuously improved after 8 weeks of treatment （ 90%, 82% ,78% ）and 12 weeks of treatment（98% ,93% ,92% ） ,and the differences were all statistically significant （F = 7.11,7.29,8.86, all P 〈 0.05）. The levels of IL - 6 after 12 weeks of treatment had no significant change compared

关 键 词：托珠单抗 全身型幼年特发性关节炎 治疗 

分 类 号：R725.9[医药卫生—儿科]