TNF-α拮抗剂治疗类风湿关节炎的临床效果  

Clinical effect of TNF-α antagonist on treatment of patients with rheumatoid arthritis

作　　者：李媛[1] 戚务芳[1] 史玉泉[1] 王萌萌[1] LI Yuan;QI Wu-fang;SHI Yu-quan;WANG Meng-meng(Tianjin First Central Hospital Tianjin 300192,China)

机构地区：[1]天津市第一中心医院风湿免疫科,天津300192

出　　处：《中华医院感染学杂志》2021年第1期73-77,共5页Chinese Journal of Nosocomiology

基　　金：天津市医药科技发展计划基金资助项目(2018132)。

摘　　要：目的探究肿瘤坏死因子-α(Tumor necrosis factorα,TNF-α)拮抗剂治疗类风湿关节炎的临床效果,及其对患者炎症反应、免疫功能的影响。方法选取2017年3月-2019年3月天津市第一中心医院治疗的84例活动期类风湿性关节炎患者,随机分为对照组和研究组,每组42例,对照组患者接受常规治疗方案(塞来昔布+甲氨蝶呤+来氟米特),研究组在对照组基础上加用TNF-α拮抗剂(重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白)治疗,两组均治疗3个月。比较两组患者临床疗效和不良事件(感染、肿胀等)发生率;记录两组患者关节症状改善情况(28个关节压痛和肿胀数、疼痛程度、晨僵时间);分析外周血调节性T细胞Treg与辅助性T细胞Th17比例、转化生长因子(TGF-β)、白细胞介素(IL-17)、C-反应蛋白(CRP)、类风湿因子(RF)、红细胞沉降率(ESR)水平变化。结果研究组治疗有效率为95.24%,显著高于对照组的80.95%(P<0.05);治疗后研究组关节压痛数、肿胀数、VAS评分及晨僵时间改善程度优于对照组(P<0.05);治疗前两组患者外周血Treg/Th17、TGF-β、IL-17、CRP、RF和ESR水平比较均无显著差异,治疗后两组患者Treg/Th17水平升高,TGF-β和IL-17水平均降低,CRP、RF、ESR水平均降低,且研究组改善程度优于对照组(P<0.05);对照组出现1例上呼吸道感染和1例消化不良,研究组出现1例上呼吸道感染、1例尿路感染、1例注射部位肿胀及1例腹泻,两组均未出现肝肾功能受损等严重不良事件。结论重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白可有效改善风湿性关节炎患者临床症状和实验室炎性指标,纠正Treg/Th17失衡,临床治疗仍需要重视其致感染风险。OBJECTIVE To explore the clinical effect of tumor necrosis factorα(TNF-α)antagonist on treatment of rheumatoid arthritis(RA)and observe the impact on inflammatory response and immune function of the patients.METHODS A total of 84 patients with active RA who were treated in the Tianjin First Central Hospital from Mar.2017 to Mar.2019 were enrolled in the study and randomly divided into the control group and the study group,with 42 cases in each group.The control group was given routine treatment regimen(celecoxib,methotrexate,leflunomide),while the study group was additionally given TNF-αantagonist(recombinant human type II TNF receptor-antibody fusion protein)on basis of the treatment of the control group,and both groups were treated for 3 months.The clinical effects and incidence of adverse reactions(infection,swelling)were compared between the two groups of patients,the improvements of joint symptoms(28 joint tenderness and swelling,pain degree,morning stiffness)were recorded,and the ratio of peripheral blood regulatory T cells(Treg)to helper T cell Th17,transforming growth factor(TGF-β)level,interleukin-17(IL-17)level,C-reactive protein(CRP)level,rheumatoid factor(RF)level and erythrocyte sedimentation rate(ESR)were observed.RESULTS The effective rate of treatment of the study group was 95.24%,significantly higher than 80.95%of the control group(P<0.05).The joint tenderness counts,swelling counts,VAS score and time of morning stiffness were improved more significantly in the study group than in the control group after the treatment(P<0.05).There were no significant differences in the levels of peripheral blood Treg/Th17,TGF-β,IL-17,CRP,RF and ESR between the two groups of patients before the treatment,the Treg/Th17 level of the two groups of patients was elevated after the treatment,the levels of TGF-βand IL-17 were reduced,the levels of CRP,RF and ESR were reduced,and the above indexes were improved more significantly in the study group than in the control group(P<0.05).There was 1 case of upper respira

关 键 词：类风湿关节炎 TNF-α拮抗剂 治疗效果 感染风险 

分 类 号：R593.22[医药卫生—内科学]