托珠单抗治疗活动性难治性类风湿关节炎的疗效及不良反应  

The ef?cacy and adverse reactions of tocilizumab in the treatment of active RRA

作　　者：徐辉[1] 邓玲[1] 李学荣[1] XU Hui;DENG Ling;LI Xue-rong(Department of Blood and Rheumatology, Chongqing Three Gorges Central Hospital, Chongqing 404000, China)

机构地区：[1]重庆三峡中心医院血液风湿免疫科,重庆404000

出　　处：《中国医刊》2019年第4期425-427,共3页Chinese Journal of Medicine

摘　　要：目的评价托珠单抗注射液治疗活动性难治性类风湿关节炎(refractory rheumatoid arthritis,RRA)的临床疗效及安全性。方法选取2014年6月至2016年6月于重庆三峡中心医院血液风湿免疫科门诊就诊的69例活动性RRA患者。所有患者均接受托珠单抗静脉注射治疗,可同时与氨甲蝶呤(methotrexate,MTX)或其他抗风湿药物(disease-modifying antirheumatic drugs,DMARDs)联用。观察治疗前及治疗后第4、8、12周时的红细胞沉降率(erythrocytesedimentationrate,ESR)、C-反应蛋白(C-reactive protein,CRP)、肿胀关节数、压痛关节数、休息痛、晨僵时间、28个关节的疾病活动度评分(disease activity score of 28 joints,DAS28)、临床疾病活动指数(clinical disease activity index,CDAI)、简化疾病活动指数(simpli?ed disease activity index,SDAI)评分,并记录不良反应发生情况。结果治疗后ESR、CRP、肿胀关节数、压痛关节数、休息痛、晨僵时间较治疗前均有不同程度改善,差异有显著性(P<0.05);对治疗前、治疗后第4、8、12周SDAI、CDAI、DAS28评分进行比较,发现治疗后第4周即有显著改善,差异有显著性(P<0.05)。本组患者均能坚持完成治疗及疗效评价,未出现严重的不良反应。结论托珠单抗能明显缓解活动性RRA患者的临床症状和体征,减轻疾病活动度,且安全性较高。Objective To evaluate the efficacy and safety of tocilizumab in the treatment of active refractory rheumatoid arthritis(RRA).Method From June 2014 to June 2016, 69 patients with active RRA who were admitted to the Department of Rheumatology and Immunology in our hospital received intravenous injection of tocilizumab. They were also treated with methotrexate(MTX) or other antirheumatic drugs(disease-modifying antirheumatic drugs, DMARDs). The patients were followed up for treatment at 4, 8, and 12 weeks after treatment. The indicators included erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), number of swollen joints, number of tender joints, rest pain, morning stiffness time, disease activity score of 28 joints(DAS28), clinical disease activity index(CDAI),simplified disease activity index(SDAI) score and record the occurrence of adverse reactions. Result After treatment, the number of ESR, CRP, swollen joints, number of tender joints, rest pain and morning stiffness were improved to different degrees before treatment.The difference was statistically significant(P<0.05). SDAI, CDAI and DAS28 scores before treatment. Compared with the 4 th, 8 th and 12 th week after treatment, it was found that there was a significant improvement at the 4 th week after treatment, and the difference was statistically significant(P<0.05). The patients enrolled in this study were able to adhere to the completion of treatment and efficacy evaluation. Serious adverse reactions occurred. Conclusion Tocilizumab can significantly alleviate the clinical symptoms and signs of active RRA patients, reduce disease activity, and have higher safety.

关 键 词：类风湿关节炎 托珠单抗 不良反应 

分 类 号：R684.3[医药卫生—骨科学]