阿达木单抗关节腔注射治疗幼年特发性关节炎11例  

Treatment of 11 cases of juvenile idiopathic arthritis by intra-articular injection of adalimumab

作　　者：迟颖[1] 赖建铭[1] 苏改秀[1] 康闽[1] 李胜男[1] 张丹[1] 王新宁[1] Chi Ying;Lai Jianming;Su Gaixiu;Kang Min;Li Shengnan;Zhang Dan;Wang Xinning(Department of Rheumatology and Immunology,Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院风湿免疫科,北京100020

出　　处：《中华儿科杂志》2022年第3期237-241,共5页Chinese Journal of Pediatrics

摘　　要：目的观察阿达木单抗(ADA)关节腔注射治疗难治性少关节型幼年特发性关节炎(JIA)的有效性及安全性。方法回顾性研究。收集2019年11月至2020年10月于首都儿科研究所附属儿童医院风湿免疫科住院治疗的仅有膝关节受累的11例难治性少关节型JIA患儿的年龄、性别、关节肿痛症状等临床资料。用药后每4周为观察点分析不同治疗时间医生、父母-患儿对疾病活动度的评价、活动性关节个数、红细胞沉降率(ESR)在血清中的水平,采用Kruskal-Wallis秩和检验比较不同治疗时间临床评价指标及实验室检查变化情况的差异。结果11例患儿中男5例、女6例,年龄3.0(2.8)岁。11例患儿均有关节肿痛及活动受限症状,3次ADA关节腔注射治疗后,11例患儿关节症状均较治疗前好转;7例患儿关节症状完全消失,在6个月随诊期间内,7例均无复发。不同治疗时间医生、父母-患儿对疾病活动度的评价、患儿活动性关节个数、ESR、幼年关节炎疾病活动评分27差异均有统计学意义(χ^(2)=53.99、59.37、32.87、40.07、54.00,均P<0.001)。治疗3个月及随访6个月中11例患儿均未见明显药物不良反应。结论关节腔注射ADA治疗难治性少关节型JIA控制关节症状效果显著且相对安全。Objective To evaluate the efficacy and safety of intra-articular injection of adalimumab(ADA)in the treatment of refractory oligoarticular juvenile idiopathic arthritis(JIA).Methods This was a retrospective study.Clinical data on age,gender,and symptoms of joint swelling and pain were collected from 11 children with refractory oligoarticular JIA involving only knee joints admitted to Department of Rheumatism and Immunology of Children′s Hospital,Capital Institute of Pediatrics from November 2019 to October 2020.The physician and parent-child evaluation of disease activity,the number of active joints,and the level of erythrocyte sedimentation rate(ESR)at different treatment time points were analyzed at every 4-week observation point after drug administration,and the non-parametric Kruskal-Wallis test was used to compare the differences in clinical evaluation indicators and changes in laboratory tests at different treatment times.The follow-up period was 6 months.Results Among the 11 children,5 were boys and 6 were girls.The age was 3.0(2.8)years.All 11 children had symptoms of joint swelling and pain as well as limitation of movement.After 3 intra-articular injections of ADA,the joint symptoms of 11 children were better than before treatment;the joint symptoms of 7 children disappeared completely,and no recurrence occurred during the 6-month follow-up period.At different treatment times,physician and parent-child evaluation of disease activity,a gradual decrease in the number of active joints in the children,ESR,and juvenile arthritis disease activity score with 27 joints were all statistically significant(χ^(2)=53.99,59.37,32.87,40.07,54.00,all P<0.001).No significant adverse drug reactions were observed in any of the 11 children during treatment and follow-up.Conclusion Intra-articular injection of ADA in the treatment of refractory oligoarticular JIA has a significant effect in controlling joint symptoms and is relatively safe.

关 键 词：关节炎 幼年型类风湿 注射 关节内 抗体 单克隆 有效性研究 安全 

分 类 号：R726.8[医药卫生—儿科]