托珠单抗脱敏治疗难治性全身型幼年特发性关节炎1例及文献复习  

Tocilizumab desensitization therapy of refractory systemic juvenile idiopathic arthritis: a case report and literature review

作　　者：李艳蝶 郑琪[1] 徐益萍[1] 卢美萍[1] 邹丽霞[1] Li Yandie;Zheng Qi;Xu Yiping;Lu Meiping;Zou Lixia(Department of Rheumatology Immunology&Allergy,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院风湿免疫过敏科,国家儿童健康与疾病临床医学研究中心,杭州310052

出　　处：《中华实用儿科临床杂志》2025年第3期220-222,共3页Chinese Journal of Applied Clinical Pediatrics

基　　金：浙江省重点研发计划(2023C03032);浙江省医药卫生科技计划项目(2021KY765)。

摘　　要：回顾2023年10月浙江大学医学院附属儿童医院收治的1例男性难治性全身型幼年特发性关节炎(sJIA)患儿的临床资料, 并进行文献复习。患儿, 男, 9岁, 因"反复发热, 伴皮疹、关节痛4年余"入院。患儿4年前被诊断为巨噬细胞活化综合征、sJIA, 病程4年, 经糖皮质激素、环孢素、甲氨蝶呤治疗病情复发3次, 既往输注托珠单抗5 min时出现过敏性休克, 由于托珠单抗过敏, 后加用Janus激酶抑制剂治疗, 现疾病再次复发, 经监护人知情同意后, 脱敏疗法应用托珠单抗240 mg, 每2周1次, 过程顺利。患儿脱敏治疗随访0.5年余, 未发生过敏反应, 病情控制良好, 醋酸泼尼松片已减至2.5 mg, 1次/d口服。目前国内外共有10例患者进行脱敏治疗, 其中男2例, 女8例, 年龄2.5~54.0岁, 均脱敏治疗成功。应用托珠单抗的脱敏疗法对临床上应用生物制剂过敏的患者具有重要意义。The clinical data of a child with refractory systemic juvenile idiopathic arthritis(sJIA)who was admitted to the Children′s Hospital,Zhejiang University School of Medicine in October 2023 were analyzed,and literature review was conducted.The patient was a 9-year-old boy,who was admitted due to recurrent fever,accompanied by rash and joint pain for more than 4 years.Four years ago,he was diagnosed with macrophage activation syndrome and sJIA.In the past 4 years,the condition recurred 3 times under treatment with glucocorticoids,Cyclosporine,and Methotrexate.He previously experienced allergic shock after 5 minutes of infusion of Tocilizumab.Due to Tocilizumab allergy,he was treated with Janus kinase inhibitors,but the disease still recurred.After informed consent was obtained from the guardian,240 mg of Tocilizumab was administrated for desensitization once every 2 weeks and the process went smoothly.The patient has been followed up for more than 6 months and no allergic reactions had occurred.The condition was well controlled,and the Prednisone acetate tablet had been reduced to 2.5 mg orally once a day.At present,there are 10 patients undergoing desensitization treatment both domestically and internationally,including 2 males and 8 females,aged between 2.5 and 54.0 years.All of them have achieved a success in desensitization.Therefore,Tocilizumab desensitization therapy is of great significance for patients who are allergic to biologics in clinical practice.

关 键 词：托珠单抗 全身型幼年特发性关节炎 脱敏治疗 

分 类 号：R73[医药卫生—肿瘤]