重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白强直性脊柱炎患者的骨质重塑及炎性因子水平影响  

The evaluate the effect of bone remodeling and serum inflammatory factors with the treatment of recombinant human tumor necrosis factor-α receptor Ⅱ IgG Fc Fusion protein in ankylosing spondylitis patients

作　　者：吴海华[1] 陈攀峰 边铁群 周慧 全仁夫[1] 胡永红[1] Wu Haihua;Chen Panfeng;Bian Tiequn;Zhou Hui;Quan Renfu;Hu Yonghong(Department of Rheumatology, Xiaoshan Traditional Chinese Medicine Hospital Hangzhou City, Hangzhou, Zhejiang,311200, China)

机构地区：[1]杭州市萧山区中医院风湿科

出　　处：《当代医学》2019年第16期7-9,共3页Contemporary Medicine

基　　金：杭州市萧山区科技局重大项目(2013310)

摘　　要：目的评价重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白(rhTNFR:Fc,益赛普)治疗AS前后血清Dickkopf-1(DKK-1)、硬化素、骨保护素(OPG)、NF-κB受体活化因子配体(RANKL)变化。方法对本院30例AS患者,rhTNFR:Fc足剂量治疗(27,脱落3例)12周后,评价治疗前后患者血清DKK-1、OPG、硬化素及RANKL水平,及BASDAI、ESR及CRP等炎症指标水平变化;采用独立样本t检验,c2检测进行统计学处理。结果经依那西谱治疗12周后,BASDAI、ESR、CRP及RANKL分别为[(2.33±0.93)、(27.00±18.11)mm/h、(17.44±7.75)mg/L)及(73.49±11.88)pg/ml]均较治疗前[(5.94±1.06)、(65.11±29.33)mm/h、(50.41±20.36)mg/L及(94.54±12.99)pg/ml]明显下降,差异具有统计学意义(P<0.05),OPG[(107.71±17.39)pg/ml,(138.38±15.36)pg/ml]明显上升(P<0.05),而DKK-1[(193.53±22.46)pg/ml,(170.89±22.36)pg/ml]及硬化素[(0.65±0.11)pg/ml,(0.64±0.11)pg/ml]水平无明显改变。相关性分析:DKK-1水平与BASDAI、CRP、ESR、OPG、RANKL均无相关性,与硬化素水平明显相关(P<0.05)。结论12周治疗后,AS疾病活动度及临床指标明显改善,Wnt信号通路抑制剂水平无明显改变,DKK-1水平与急性时相蛋白等不相关。Objective To explore the effect of bone remodeling and serum inflammatory factors in patients with ankylosing spondylitis (AS) treated with recombinant human tumor necrosis factor-αreceptor II IgG: Fc Fusion protein (rhTNFR:Fc). Methods 30 AS patients were treated with rhTNFR: Fc (27cases,3cases lost) for 12 weeks. Markers of bone remodelling and inflammation were assessed at baseline and after 3 months. Results After the TNF-α inhibitor treatment, BASDAI、ESR、CRP and RANKL decreased significantly from [(5.94±1.06)、(65.11±29.33)mm/h、(50.41±20.36)mg/L and (94.54±12.99)pg/ml] to [(2.33±0.93)、(27.00±18.11)mm/h、(17.44±7.75)mg/L)and (73.49±11.88)pg/ml], and the differences were statistically significant (P<0.05), OPG increased significantly from (107.71±17.39) pg/ml to (138.38±15.36) pg/ml (P<0.05), but the changes of DKK-1 (193.53±22.46 vs 170.89±22.36) pg/ml and sclerostin (0.65±0.11 vs 0.64±0.11) pg/ml were not statistically significant;There were no relations between DKK-1 and BASDAI, ESR, CRP, OPG and RANKL. Conclusion RhTNFR: Fc may improve the clinical indicators and inflammation significantly, and may have influence on bone remodel pattern through OPG/RANK/RANKL system, instead of Wnt pathway.

关 键 词：脊柱炎 强直性 骨重塑 TNF-Α抑制剂 急性时相蛋白 

分 类 号：R593.23[医药卫生—内科学]