枸橼酸托法替布治疗结缔组织病相关性间质性肺疾病的效果  

Therapeutic Effect of Tofacitinib Citrate on Connective Tissue Disease Associated Interstitial Lung Disease

作　　者：欧阳楚君[1] 黄志贞 卢瑞荣 韦锋[1] 梁灼源[1] 冯明亮[1] 郭静静[1] OUYANG Chujun;HUANG Zhizhen;LU Ruirong;WEI Feng;LIANG Zhuoyuan;FENG Mingliang;GUO Jingjing(Jiangmen Central Hospital,Guangdong Province,Jiangmen 529000,China)

机构地区：[1]广东省江门市中心医院,广东江门529000

出　　处：《中国医学创新》2022年第33期6-12,共7页Medical Innovation of China

基　　金：白求恩·医学科学研究基金(TY157DS);广东省江门市科技计划项目(2020YLA121)。

摘　　要：目的:探讨枸橼酸托法替布对结缔组织病(CTD)相关间质性肺疾病(ILD)的疗效及安全性。方法:2020年3月-2021年3月根据纳排标准共纳入江门市中心医院52例CTD-ILD患者,并根据治疗方法不同分为治疗组(使用甲氨蝶呤10 mg,1次/周+枸橼酸托法替布5 mg/次,2次/d)30例和对照组(甲氨蝶呤10 mg,1次/周+来氟米特10 mg,1次/d)22例,分析对比两组实验室检查指标、肺通气功能指标、高分辨(HR)CT评分及不良事件发生情况,治疗12个月后观察结果。结果:治疗后,治疗组HRCT炎症指数积分较治疗前明显下降,且较对照组明显低(P<0.05),两组HRCT纤维化积分对比差异均无统计学意义(P>0.05)。治疗后,治疗组的FEV_(1)、FEV_(1)最佳值、FEV_(1)/FVC%、MEF、MEF_(25)、MEF_(25)最佳值、MEF_(75)最佳值均较对照组明显高(P<0.05),治疗组的ESR和CRP水平均较对照组明显低(P<0.05),两组的其他肺通气功能指标和实验室检查指标对比差异均无统计学意义(P>0.05)。对照组并发感染发生率为36.36%(8/22),高于治疗组的13.33%(4/30),但差异无统计学意义(P=0.051)。结论:枸橼酸托法替布联合甲氨蝶呤治疗CTD-ILD较甲氨蝶呤联合来氟米特能有效减轻在肺部CT上的炎症渗出,改善通气功能,但对其纤维化进展暂未显现疗效。Objective:To investigate the efficacy and safety of Tofacitinib Citrate in connective tissue disease(CTD)related interstitial lung disease(ILD).Method:A total of 52 CTD-ILD patients who met the inclusion and exclusion criteria in Jiangmen Central Hospital from March 2020 to March 2021 were included and divided into treatment group(Methotrexate 10 mg,once a week+Tofacitinib Citrate 5 mg,two times a day)(n=30)and control group(Methotrexate 10 mg,once a week+Leflunomide 10 mg,once a day)(n=22)by treatment method.Laboratory examination,pulmonary ventilation function,the high-resolution(HR)CT scores and the incidence of adverse events between the two groups were analyzed and compared.The outcome of 12 months after treatment were observed.Result:After treatment,the HRCT inflammation index scores in the treatment group decreased significantly compared with that before treatment,and was significantly lower than that in the control group(P<0.05);there was no significant difference in HRCT fibrosis score between the two groups(P>0.05).After treatment,the FEV_(1),FEV_(1)optimal value,FEV_(1)/FVC%,MEF,MEF_(25),MEF_(25)optimal value,MEF_(75)optimal value in the treatment group were significantly higher than those in the control group(P<0.05),and the levels of ESR and CRP in the treatment group were significantly lower than those in the control group(P<0.05).There were no statistical differences between the two groups in other pulmonary ventilation function indexes and laboratory examination indexes(P>0.05).The incidence of concurrent infection in the control group was 36.36%(8/22),which was higher than 13.33%(4/30)in the treatment group,but the difference was not statistically significant(P=0.051).Conclusion:Tofacitinib Citrate combined with Methotrexate can effectively reduce inflammatory exudation in the treatment of CTD-ILD,which is better than Methotrexate combined with Leflunomide,but it has no effect on the progress of fibrosis.

关 键 词：结缔组织病 间质性肺疾病 枸橼酸托法替布 

分 类 号：R593.2[医药卫生—内科学] R563[医药卫生—临床医学]