托法替布治疗类风湿关节炎肺间质病变的疗效评估  

Analysis of clinical efficacy of tofacitinib in the treatment of rheumatoid arthritis with interstitial lung disease

作　　者：王田玲 崔佳佳 沈芹 杨沅浩 胡怀霞[1] 李慧 Wang Tianling;Cui Jiajia;Shen Qin;Yang Yuanhao;Hu Huaixia;Li Hui(Department of Rheumatology and Immunology,The Second People's Hospital of Lianyungang,Lianyungang 222000,China)

机构地区：[1]江苏省连云港市第二人民医院风湿免疫科,222000

出　　处：《国际医药卫生导报》2021年第20期3181-3185,共5页International Medicine and Health Guidance News

基　　金：连云港市科技项目(SH1535);连云港市第二人民医院院中青年医学人才成长基金项目(TQ202005)。

摘　　要：目的评估枸橼酸托法替布治疗类风湿关节炎肺间质病变(RA-ILD)的效果。方法选择连云港市第二人民医院2018年12月至2020年5月初诊RA-ILD患者100例纳入临床研究,按随机数字表法分为2组。治疗组男22例、女28例,年龄(46.32±9.17)岁;对照组男19例、女31例,年龄(45.34±9.25)岁。对照组给予糖皮质激素治疗,治疗组在此基础上加用枸橼酸托法替布。比较两组患者治疗半年前后症状评分、实验室指标、影像学评分及血清中Ⅱ型肺泡细胞表面抗原(KL-6)、白细胞介素(IL)-8、IL-38水平的变化。结果①治疗后两组的临床症状,血小板计数(PLT)、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)水平,肺高分辨率CT(HRCT)评分以及用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1/FVC均较治疗前改善(均P<0.05),且治疗组的效果远胜于对照组(均P<0.05)。②治疗后治疗组KL-6(210.82±34.78)U/ml、IL-8(5.12±1.78)ng/L较对照组KL-6(328.17±82.26)U/ml、IL-8(8.23±2.21)ng/L低,IL-38(28.08±1.16)ng/L较对照组(21.45±1.65)ng/L高,差异均有统计学意义(均P<0.05)。结论枸橼酸托法替布能有效地治疗RA-ILD,改善临床症状、提高生活质量,具有良好的安全性,其作用机制可能与血清中KL-6、IL-8、IL-38水平变化有关。Objective To investigate the clinical efficacy of tofacitinib citrate in the treatment of rheumatoid arthritis with interstitial lung disease(RA-ILD).Methods A total of 100 patients with RA-ILD in The Second People's Hospital of Lianyungang from December 2018 to May 2020 were selected and were divided into two groups with the random number table method.In the treatment group,there were 22 males and 28 females,with an age of(46.32±9.17)years old;in the control group,there were 19 males and 31 females,with an age of(45.34±9.25)years old.The control group was treated with glucocorticoids,and the treatment group was treated with tofacitinib citrate on the basis.The differences of symptom scores,laboratory indexes,imaging scores,and serum Krebs yon denlungen(KL-6),interleukin(IL)-8,and IL-38 levels were compared between the two groups before and after half a year of treatment.Results①The clinical symptoms,platelet counts(PLT),erythrocyte sedimentation rates(ESR),C-reactive protein(CRP)and rheumatoid factor(RF)levels,lung high resolution CT(HRCT)scores,forced vital capacities(FVC),forced expiratory volumes in the first second(FEV1),and FEV1/FVC of the two groups after the treatment were improved compared with those before the treatment(all P<0.05),and the effects in the treatment group were much better than those in the control group(all P<0.05).②After the treatment,the levels of KL-6[(210.82±34.78)U/ml]and IL-8[(5.12±1.78)ng/L]in the treatment group were lower than those in the control group[(328.17±82.26)U/ml and(8.23±2.21)ng/L],the level of IL-38[(28.08±1.16)ng/L]was higher than that in the control group[(21.45±1.65)ng/L],with statistically significant differences(all P<0.05).Conclusion Tofacitinib citrate can effectively treat RA-ILD,improve the clinical symptoms and quality of life in patients,and has good safety,its mechanism may be related to the changes of serum KL-6,IL-8,and IL-38 levels.

关 键 词：托法替布 类风湿关节炎 肺间质病变 KL-6 IL-8 IL-38 

分 类 号：R593.22[医药卫生—内科学] R563[医药卫生—临床医学]