干扰素α2a治疗难治性白塞葡萄膜炎:长期随访研究  

Interferonα2a in the treatment of refractory Behcet's uveitis:a long-term follow-up study

作　　者：张孟昊 史婧 刘金晶 周佳鑫 高斐 赵潺 郑文洁 ZHANG Meng-hao;SHI Jing;LIU Jing-jing;ZHOU Jia-xin;GAO Fei;ZHAO Chan;ZHENG Wen-jie(Department of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Key Laboratory of Rheumatology&Clinical Immunology,Ministry of Education,National Clinical Research Center for Dermatologic and Immunologic Diseases(NCRC-DID),Beijing 100730,China;Department of Rheumatology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Ophthalmology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Key Laboratory of Ocular Fundus Diseases,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院风湿免疫科,国家皮肤与免疫疾病临床医学研究中心(NCRC-DID),疑难重症及罕见病国家重点实验室,风湿免疫病学教育部重点实验室,北京100730 [2]复旦大学附属中山医院风湿免疫科,上海200032 [3]中国医学科学院北京协和医学院北京协和医院眼科,中国医学科学院眼底疾病重点实验室,北京100730

出　　处：《中华临床免疫和变态反应杂志》2022年第4期388-394,共7页Chinese Journal of Allergy & Clinical Immunology

基　　金：国家自然科学基金面上项目(81871299,82171800)。

摘　　要：目的探讨干扰素α2a(interferonα2a,IFNα2a)治疗难治性白塞葡萄膜炎(Behcet's uveitis,BU)长期疗效和安全性。方法收集40例应用IFNα2a的难治性BU临床资料。评估IFNα2a长期疗效、不良反应、激素免疫抑制剂节约效应及停用IFNα2a后BU长期缓解情况。结果40例患者均为全葡萄膜炎,用IFNα2a前最低糖皮质激素(glucocorticoid,GC)用量中位数20(15~60)mg d,60%联合2种以上免疫抑制剂(immunosuppressive drug,ISD)。IFNα2a疗程中位数32(6~74)个月,中位随访58(12~81)个月后,BU年中位复发次数由5.5(1~24)次减少至0(0~3)次(P<0.0001)。末次用药时,最小GCs用量中位数减少至5(0~15)mg d(P=0.0001),ISD种类由1.71(1.71±0.61)种减少至0.57(0.57±0.63)种(P<0.0001)。末次随访时13例(32.5%)停GCs,19例(47.5%)停ISD。停用过IFNα2a的29例患者中,眼科稳定1年以上停药15例(51.7%),其中12、24、36个月和超过36个月后BU复发率分别为6.7%、6.7%、6.7%和13.3%。未见严重不良反应。结论长期应用IFNα2a对难治性BU有较好的疗效、安全性及长期缓解效果,有明显的GCs和ISDs节约效应。Objective To investigate the long-term efficacy and safety of interferonα2a(IFNα2a)treatment in patients with refractory Behcet's uveitis(BU).Methods The clinical data of 40 patients with refractory BU treated with IFNα2a in Peking Union Medical College Hospital from February 2015 to November 2021 were collected.The long-term efficacy of IFNα2a treatment,changes in uveitis relapse rate,potential side effects,glucocorticoids(GCs)and immunosuppressant-sparing effects,and the long-lasting remission of uveitis after discontinuation of IFNα2a treatment were observed and evaluated.Results All 40 patients(35 males and 5 females)had recurrent sight-threatening pan-uveitis.The median dosages of GCs were 20(15-60)mg d,and 60%of patients were treated with at least two immunosuppressive agents before IFNα2a treatment.The median course of IFNα2a treatment was 32(6-74)months,after a median follow-up for 58(12-81)months,the median rate of uveitis relapse decreased notably from 5.5(1-24)times year to 0(0-3)times year(P<0.0001).At the time of the last IFNα2a treatment,the median minimum GCs dosage decreased to 5(0-15)mg d(P=0.0001),and immunosuppressants used decreased from 1.71(1.71±0.61)types to 0.57(0.57±0.63,P<0.0001)types.At the last follow-up,13(32.5%,1340)and 19(47.5%,1940)patients withdrawed GCs and immunosuppressants,respectively.Among 29 patients who had suspended IFNα2a,15 patients(51.7%)suspended due to uveitis stability for more than 1 year.After suspending IFN treatment for 12,24,36,and more than 36 months,the relapse rates of uveitis were 6.7%,6.7%,6.7%,and 13.3%,respectively.No serious adverse reactions were observed.Conclusions Long-term administration of IFNα2a has promising efficacy,safety,and a long-lasting remission effect on refractory BU,with favorable GCs-and immunosuppressant-sparing effect.

关 键 词：白塞病 葡萄膜炎 干扰素Α2A 

分 类 号：R773[医药卫生—眼科] R597[医药卫生—临床医学]