托法替布联合传统合成抗风湿药物治疗难治性类风湿关节炎的疗效与安全性分析  

Efficacy and safety of tofacitinib in the treatment of refractory rheumatoid arthritis

作　　者：宋冬云 刘睿 马锐 郭静 崔璨 SONG Dong-yun;LIU Rui;MA Rui(Department of Rheumatology,Second Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China)

机构地区：[1]徐州医科大学第二附属医院风湿免疫科,221006

出　　处：《中国现代药物应用》2023年第6期22-25,共4页Chinese Journal of Modern Drug Application

摘　　要：目的分析托法替布联合传统合成抗风湿药物治疗难治性类风湿关节炎(RA)的疗效与安全性。方法40例难治性RA患者,均给予托法替布联合传统合成抗风湿药物治疗。比较治疗前后关节肿胀数、关节压痛数、类风湿因子(RF)、红细胞沉降率(ESR)、C反应蛋白(CRP)、28个关节疾病活动度指数(DAS28)等指标,并分析其疾病改善情况,通过评估治疗前后血常规、肝肾功等指标分析其药物治疗安全性。结果治疗前RF为(367.91±388.93)IU/ml,CRP为(74.88±116.17)mg/L,ESR为(75.70±23.30)mm/h,DAS28评分为(5.97±0.53)分;治疗4周后RF为(246.04±317.81)IU/ml,CRP为(37.32±75.50)mg/L,ESR为(45.85±20.66)mm/h,DAS28评分为(4.86±0.67)分;治疗12周后RF为(155.68±240.46)IU/ml,CRP为(21.71±48.38)mg/L,ESR为(26.65±20.23)mm/h,DAS28评分为(3.12±1.09)分。治疗4周后,ESR、DAS28评分明显低于治疗前,差异有统计学意义(P<0.01);RF、CRP与治疗前比较,差异无统计学意义(P>0.05)。治疗12周后,RF、CRP、ESR水平及DAS28评分均明显低于治疗前,差异有统计学意义(P<0.01)。治疗前及治疗4、12周后,关节肿胀数分别为(11.05±3.30)、(6.60±2.54)、(1.98±1.79)个,关节压痛数分别为(12.18±3.42)、(7.38±3.00)、(2.33±1.82)个;治疗4、12周后,关节肿胀数和关节压痛数均明显少于治疗前,差异有统计学意义(P<0.05)。治疗过程中1例患者发生头痛,1例患者出现胃肠道反应,1例患者出现上呼吸道感染,无严重不良反应出现。血常规和肝肾功能指标均未发生异常,未发生骨髓抑制及肝肾功能损害。结论托法替布联合传统合成抗风湿药物治疗难治性RA安全有效,可明显改善患者的炎性指标,降低疾病活动度,减少关节肿胀数和关节压痛数,值得临床推广应用。Objective To analyze the efficacy and safety of tofacitinib in the treatment of refractory rheumatoid arthritis(RA).Methods 40 patients with refractory RA were treated with tofacitinib combined with conventional synthetic anti-rheumatic drugs.The swollen joint count,tender joint count,rheumatoid factor(RF),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),disease activity score 28 joint(DAS28)were compared before and after treatment and their disease improvement was analyzed,and the safety of drug treatment was analyzed by assessing the blood routine and liver and kidney function before and after treatment.Results Before treatment,RF was(367.91±388.93)IU/ml,CRP was(74.88±116.17)mg/L,ESR was(75.70±23.30)mm/h,and DAS28 score was(5.97±0.53)points;after 4 weeks of treatment,RF was(246.04±317.81)IU/ml,CRP was(37.32±75.50)mg/L,ESR was(45.85±20.66)mm/h,and DAS28 score was(4.86±0.67)points;after 12 weeks of treatment,RF was(155.68±240.46)IU/ml,CRP was(21.71±48.38)mg/L,ESR was(26.65±20.23)mm/h,and DAS28 was(3.12±1.09)points.After 4 weeks of treatment,ESR and DAS28 score were significantly lower than those before treatment,and the differences were statistically significant(P<0.01);RF and CRP had no statistically significant difference compared with those before treatment(P>0.05).After 12 weeks of treatment,the RF,CRP,ESR levels and DAS28 score were significantly lower than those before treatment,and the difference was statistically significant(P<0.01).Before and after 4 and 12 weeks of treatment,the swollen joint count were(11.05±3.30),(6.60±2.54)and(1.98±1.79)joints,and the tender joint count were(12.18±3.42),(7.38±3.00)and(2.33±1.82)joints.After 4 and 12 weeks of treatment,the swollen joint count and tender jointcount were significantly less than those before treatment,and the difference was statistically significant(P<0.05).Headache occurred in 1 patient,gastrointestinal reaction in 1 patient and upper respiratory tract infection in 1 patient during the treatment,and no serious adverse reacti

关 键 词：类风湿关节炎 托法替布 传统合成抗风湿药物 类风湿因子 

分 类 号：R593.22[医药卫生—内科学]