托珠单抗对肿瘤坏死因子―α拮抗剂反应不佳和初治类风湿关节炎患者疗效评价.docVIP

托珠单抗对肿瘤坏死因子―α拮抗剂反应不佳和初治类风湿关节炎患者疗效评价 　　[摘要] 目的 比较托珠单抗在治疗使用肿瘤坏死因子-α拮抗剂治疗不佳的和初治活动性类风湿关节炎患者的疗效差异性。 方法 选取2014年10月～2016年6月确诊的类风湿关节炎患者40例，其中曾使用过肿瘤坏死因子-α拮抗剂反应不佳的转换组患者20例、初治的患者20例，联合甲氨蝶呤治疗，分别记录两组患者治疗前、治疗后第4、8、12周的临床症状、实验室指标变化及不良反应情况，并进行分析对比。 结果 两组患者治疗前、治疗后的各项临床症状及实验室指标均有明显改善，差异有统计学意义（P均0.05）；初治组在第4、8、12周的血沉、DAS28评分显著低于转换组，差异有统计学意义（P均0.05）；初治?M在第8、12周的CRP显著低于转换组，差异有统计学意义（P均0.05）；初治组患者第12周的疼痛评分显著低于转换组，差异有统计学意义（t=2.11，P0.05）。 结论 托珠单抗能有效改善对肿瘤坏死因子-α拮抗剂反应不佳的和未曾使用过生物制剂患者的病情，但对后者的治疗效果更好。 　　[关键词] 类风湿关节炎；托珠单抗；肿瘤坏死因子；白介素-6 　　[中图分类号] R725.9 [文献标识码] B [文章编号] 1673-9701（2017）08-0098-04 　　[Abstract] Objective To evaluate the effects of tocilizumab between patients with rheumatoid arthritis who switched from tumor necrosis factor-α inhibitors and those who were biologics-naive. Methods Totally 40 patients with rheumatoid arthritis from October 2014 to June 2016 were divided into switched group（20 cases）， naive group （20 cases）. The drugs were administered by infusion along with stable dose of methotrexate. Clinical variables， disease activity and adverse effects were evaluated at the baseline，4 weeks，8 weeks and 12 weeks after the treatment. Results There were significant statistical differences in the changes of clinical variables between pretherapy and post-treatment（all P0.05）. The naive group was more efficient in lowering the erythrocyte sedimentation rate， disease activity score 28（DAS28）at 4 weeks， 8 weeks and 12 weeks（all P0.05）. The naive group was more efficient in lowering the CRP level at 8 weeks and 12 weeks（all P0.05）. The naive group was more efficient in lowering the patient’s assessment of pain at 12 weeks（t=2.11， P0.05）. Conclusion Tocilizumab is safe，clinically effective for patients with inadequate responses to anti-TNF therapy and for those who are biologics-nave， and it is more effective among the latter. 　　[Key words] Rheumatoid arthritis； Tocilizumab； Tumor necrosis factor； Interleukin-6 　　类风湿关节炎（rheumatoid arthritis，RA）是一种以侵蚀性关节炎为主要表现的全身性自身免疫性疾病。许多炎症因子参与了类风湿关节