中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (05): 289-293.doi: 10.3969/j.issn.1671-4091.2015.05.008

• 临床研究 • 上一篇    下一篇

免疫吸附联合生物制剂重组人肿瘤坏死因子受体融合蛋白治疗类风湿关节炎的临床研究

杨锋,程永静,黄慈波,高明,黄嘉,王钱,陈颖娟,穆冰瑶   

  1. 卫生部北京医院风湿免疫科
  • 收稿日期:2014-05-26 修回日期:2015-02-13 出版日期:2015-05-12 发布日期:2015-05-29
  • 通讯作者: 黄慈波huangcibo1208@139.com E-mail:huangcibo1208@139.com

Immunoadsorption in Combination with Recombinant Human Tumor Necrosis Factor Receptor Fusion Protein in the Treatment of Rheumatoid Arthritis

  • Received:2014-05-26 Revised:2015-02-13 Online:2015-05-12 Published:2015-05-29

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摘要： 【摘要】目的比较免疫吸附联合生物制剂重组人肿瘤坏死因子受体融合蛋白及生物制剂重组人肿瘤坏死因子受体融合蛋白治疗类风湿关节炎的临床疗效及安全性。方法分析2008 年1 月～2013 年6 月在北京医院风湿免疫科住院的活动性类风湿关节炎患者共65 例，按照治疗方案不同，分为免疫吸附联合生物制剂重组人肿瘤坏死因子受体融合蛋白组(38 例)，生物制剂重组人肿瘤坏死因子受体融合蛋白组(27 例)，免疫吸附联合组给予免疫吸附治疗，共3 次，每次间隔7 天，之后给予生物制剂重组人肿瘤坏死因子受体融合蛋白治疗3 个月，同时并序贯服用传统缓解病情的抗风湿药(DMARDs)；生物制剂组给予重组人肿瘤坏死因子受体融合蛋白治疗3 个月，同时并序贯服用DMARDs，2 组患者在性别、年龄、病程及疾病活动度方面无统计学差异。观察治疗前及治疗后4 周、24 周患者关节疼痛数，关节肿胀数，晨僵时间，血沉，CRP，同时记录患者治疗前后VAS 评分，DAS28 评分，HAQ 评分，患者对疾病总体评价及医生对疾病总体评价，计算两组患者ACR 20,50,70 缓解率及治疗期间发生的不良反应。结果治疗4 周后，免疫吸附联合组的关节疼痛数，关节肿胀数，晨僵时间，血沉及CRP 的改善与生物制剂组比较，差异有统计学意义(Z =2.733，2.604，2.366，4.137，2.952，P＜0.05)，同样，2 组治疗后4 周的DAS28 评分、HAQ 评分比较，差异有统计学意义(Z =4.134，3.262，P＜0.05)；治疗24 周后，免疫吸附联合组ACR20，50，70 分别为94.7%，92.1%，81.5%，生物制剂组为74.1%，59.3%，44.4%，2 组比较差异有统计学意义(χ2=4.050，10.077，9.721，P＜0.05)。结论免疫吸附联合生物制剂重组人肿瘤坏死因子受体融合蛋白治疗类风湿关节炎起效快，能很快诱导患者疾病缓解，未明显增加不良反应的发生，是活动性类风湿关节炎治疗的一项有益尝试。

关键词: 类风湿关节炎, 免疫吸附, 重组人肿瘤坏死因子受体融合蛋白, 诱导缓解

Abstract: 【Abstract】Objective To investigate the efficacy and safety of immunoadsorption combined with recombinant human tumor necrosis factor receptor fusion protein for the treatment of active rheumatoid arthritis. Methods We analyzed 65 active rheumatoid arthritis patients in this study. In combined group, 38 patients
were treated with immunoadsorption combined with recombinant human tumor necrosis factor receptor fusion protein and disease- modifying anti- rheumatic drugs (DMARDs, LEF or MTX); In biological agent group, 27 patients were treated with recombinant human tumor necrosis factor receptor fusion protein and
DMARDs (LEF or MTX). Clinical symptoms and laboratory examination changes were collected before and after treatment for 4 weeks and 24 weeks. Clinical assessments used the American College of Rheumatology criteria (ACR). Adverse events were evaluated during the treatment. Results All patients completed the treatment. At the treatment for 4 weeks, the improvement of tender joint counts, swollen joint counts, time of morning stiffness, ESR and CRP were greater in combined group than in biological agent group (Z=2.733, 2.604, 2.366, 4.137, 2.952, respectively, P＜0.05), and the improvement of DAS28 and HAQ scores were also greater in combined group than in biological agent group (Z=4.134 and 3.262, respectively, P＜0.05). At thetreatment for 24 weeks, the rates of ACR20, ACR50, and ACR70 were 94.7%, 92.1% and 81.5%, respectively, in combined group, and were 74.1%, 59.3% and 44.4%, respectively, in biological agent group (χ2=4.050, 10.077 and 9.721, respectively; P＜0.05). Conclusion Immunoadsorption in combination with recombinant human tumor necrosis factor receptor fusion protein significantly altered the signs and symptoms of rheumatoid arthritis, suggesting that this therapy may be an alternative for the remission induction of rheumatoid arthritis.

Key words: Rheumatoid arthritis, Immunoadsorption, Recombinant human tumor necrosis factor receptor fusion protein, Remission induction