免疫吸附联合英夫利西单抗治疗对重症类风湿关节炎患者病情改善的疗效分析  

The efficacy of immunoadsorption with Infliximab theraepy on the modulation of disease activity in patients with severe rheumatoid arthritis

作　　者：邢一达[1] 王红江[1] 孔晓丹[1] 刘昌妍[1] 崔东源[1] 张琦 Xing Yida;Wang Hongjiang;Kong Xiaodan;Liu Changyan;Cui Dongyuan;Zhang Qi(Department of Rheumatology, the Second Hospital of Dalian Medical University, Dalian 116027, China)

机构地区：[1]大连医科大学附属第二医院风湿免疫科,116027

出　　处：《中华医学杂志》2018年第23期1849-1853,共5页National Medical Journal of China

基　　金：辽宁省科技厅科学技术计划项目（2015020298）,大连市医学科学研究计划项目（1712041）,大连市自身抗体检测重点实验室基金项目

摘　　要：目的通过对重症类风湿关节炎（RA）患者临床资料的回顾性研究，分析英夫利西单抗（IFX）联合甲氨蝶呤治疗前，给予2次免疫吸附治疗对重症RA患者病情的改善情况。方法回顾性分析大连医科大学附属第二医院风湿免疫科2015年4月至2017年8月诊治的90例重症RA患者临床数据，其中43例接受IFX3mg／kg＋甲氨蝶呤治疗为对照组；47例为试验组，在开始IFX3mg／kg＋甲氨蝶呤治疗前额外接受2次免疫吸附治疗；收集患者同期临床及实验室资料。对比研究免疫吸附联合治疗对重症RA的疗效及安全性。结果患者基线年龄、性别、病程及病情两组间差异无统计学意义（P〉0．05），具有可比性；治疗后患者关节疾病活动度评分（DAS28-ESR）评分、红细胞沉降率（ESR）和C反应蛋白（CRP）水平均较基线显著降低（P〈0．05），试验组降低程度明显优于对照组（P〈0．05），且差异可持续维持至30周（P〈0．05）；治疗2及6周时，试验组患者ACR20缓解率分别为46．81％及68．08％，明显高于对照组（P〈0．05）；治疗30周时，试验组ACR20缓解率超过90％，而对照组ACR20缓解率为79．07％，DAS28-ESR临床缓解及低疾病活动度也达到了72．34％，高于对照组的48．84％（P〈0．05）。结论联合免疫吸附治疗可快速缓解重症RA患者的病情，临床疗效优于IFX3mg／kg＋甲氨蝶呤，安全性较好。Objective To evaluated the efficacy of additional immunoadsorption therapy （2 times） besides infliximab （IFX） ondisease remission in patients with severe rheumatoid arthritis （R.A）. Methods 90 patients with serve RA were included in this study. There were 43 patients in the control group who were treated with IFX 3 mg/kg ＋ methotrexate （MTX） therapy, and other 47 patients were experimental group, who were previous given 2 times additional immunoadsorption therapy before IFX 3 mg/kg ＋ MTX therapy. IFX 3 mg/kg was infused at weeks 0, 2, 6, 14, 22 and 30. Age, sex ration, mean disease duration and core index of disease activity in two treatment groups were collected at weeks 0, 2, 6 and 30 weeks to compare the efficacy and safety of combined immunosorbent therapy in the treatment of severe RA. Results The baseline age, sex ration and core indexes of disease activity were comparable between the two treatment groups （ P 〉 0. 05 ）. After treatment, the core indexes of disease activity of all patients decreased significantly compared with their baseline levels （ P 〈 0. 05 ） and the difference of sustainable maintenance to 30 weeks （P 〈 0. 05 ）. After 2 and 6 weeks of treatment, patients＇ ACR20 remission rates of the experimental group were 46. 81% and 68. 08%, significantly higher than the control group; after 30 weeks of treatment, patients＇ ACR20 remission rates of the experimental group was more than 90%, while the number was 79. 07% in the control group. At the same time DAS28-ESR clinical remission and low disease activity also reached 72.34% in the experimental group, higher than the control group （P〈0.05）. Conclusion Additional immunoadsorption therapy can rapid relive the disease activity of serve RA patients, and the remission rate of 30W was significantly higher than only IFX treatment.

关 键 词：免疫吸附 英夫利西单抗 重症类风湿关节炎 甲氨蝶呤 

分 类 号：R593.22[医药卫生—内科学]