英夫利昔与依那西普治疗幼年特发性关节炎临床观察

发布时间：2018-06-05 04:18

本文选题：英夫利昔 + 依那西普　；参考：《重庆医科大学》2012年硕士论文

【摘要】：目的：探讨英夫利昔单抗（Infliximab）与依那西普（Etanercept）治疗幼年特发性关节炎（JIA）的近期临床疗效及不良反应。方法：选择2008年6月至2012年3月间在重庆医科大学附属儿童医院免疫科住院或门诊随访使用肿瘤坏死因子（TNF）拮抗剂治疗JIA的患儿共30例，JIA的诊断与分类参照2001年国际风湿病学联盟（ILAR）JIA标准，分2组，英夫利昔组15例，，依那西普组15例。通过疾病活动性评价DAS28，有效率、临床非活动期标准、临床缓解（服药/未服药）标准等评价临床疗效；通过肝肾功、尿常规等指标评价两种药物的不良反应。用药方法：英夫利西：3～5mg/kg/次静脉滴注，分别于0、2、6周注射，之后每8周一次，疗程最长34个月；依那西普：0.4mg/kg/次（最大25mg）皮下注射，2次/周，疗程最长31个月，同时两组病人均联合甲氨蝶呤口服治疗。结果：观察3-34月，两组的临床症状和实验室指标均有改善。依那西普组6个月后CPR较治疗前有明显下降（P0.05）；英夫利昔组3、6个月和依那西普组3、6、12个月后的关节肿胀数及关节压痛（或活动时疼痛）数较治疗前均下降明显（P0.05）。两组治疗前后DAS28比较，依那西普组DAS28下降明显，3、6个月后较治疗前均有显著性差异（P0.05）；英夫利昔组在治疗3个月时的DAS28较前有显著性差异（P0.05）。两组间疗效通过关节体征、辅查、DAS28评分值和DAS28变化值所评判出的治疗反应效果分别比较均无统计学意义（P0.05），在治疗3、6个月时，依那西普组DAS28下降幅度较英夫利昔组明显，而12个月时后者DAS28低于前者。英夫利昔组和依那西普组达到JIA临床疾病非活动标准分别为3例（20.0%）和6例（40.0%），达到临床缓解（服药）标准分别为1例（6.7%）和5例（33.3%）。依那西普组最常见的不良反应主要是注射部位红肿、瘙痒，英夫利昔组是皮疹和情绪烦躁。结论：本研究发现英夫利昔及依那西普治疗JIA有明显的临床缓解作用，能显著降低患儿的DAS28评分，改善JIA的关节功能，用药过程中对肝肾功能无明显损害。二者的短期治疗效果无明显统计学差异，治疗过程中未发生严重的不良反应。
[Abstract]:Objective: to investigate the clinical efficacy and side effects of infliximab and Etanerceptin in the treatment of juvenile idiopathic arthritis (JIA). Methods: from June 2008 to March 2012, 30 children with JIA were treated with TNF- 伪 antagonist in the Department of Immunology, affiliated Children's Hospital of Chongqing Medical University. The diagnosis and classification of TNFA were compared with 2001. International Union of Rheumatology, ILARN JIA Standard, The patients were divided into 2 groups, 15 cases in the infliximab group and 15 cases in the etanisepine group. The clinical efficacy was evaluated by DAS28, effective rate, clinical inactive stage standard, clinical remission (medication / non-medication) standard, and the adverse reactions of two drugs were evaluated by liver and kidney function, urine routine and so on. Methods: Inflessie: 5 mg / kg / kg intravenously, respectively, was injected every 8 weeks for 34 months at 0 ~ 2g / kg for 6 weeks, followed by subcutaneous injection of 0.4 mg / kg / time (up to 25 mg / time) for a maximum of 31 months at the time of treatment of Ernesep: 0.4 mg / kg / time (up to 25 mg / time), the maximum duration of treatment was 31 months, and the duration of treatment was as high as 31 months. Both groups were treated with oral methotrexate. Results: the clinical symptoms and laboratory indexes of the two groups were improved in 3-34 months. The number of joint swelling and joint tenderness (or movement pain) decreased significantly after 12 months in the group of infliximab 3 months, 6 months after treatment and 6 months after treatment, and the number of joint tenderness (or pain during movement) decreased significantly after 12 months of treatment in the group of Irnathep and the group of infliximab at 3 months, 6 months after treatment and 6 months after treatment, and the number of joint tenderness (or pain during movement) decreased significantly in the group of infliximab after treatment. Compared with the two groups before and after treatment, the DAS28 of the etanerp group decreased significantly by 3%, and after 6 months there was a significant difference between the two groups (P 0.05), and the DAS28 of the infliximab group at 3 months after treatment was significantly different from that of the former group (P 0.05). The curative effect of the two groups was evaluated by joint sign, DAS28 score and DAS28 change value, respectively. There was no significant difference in the therapeutic response between the two groups. At 3,6 months after treatment, the decrease of DAS28 in the etanasip group was more obvious than that in the inflexion group. At 12 months, the DAS28 of the latter was lower than that of the former. In the inflexion group, the inactive standard of JIA was 3 cases (20.0%) and 6 cases (40.0%), and the clinical remission (drug taking) standard was 1 case (6.7g) and 5 cases (33.3g), respectively. The most common adverse effects in the Enazepine group were redness and itching at the injection site, and rash and emotional irritability in the infliximab group. Conclusion: in this study, it was found that infliximab and enazeptide could significantly reduce the DAS28 score, improve the joint function of JIA, and have no obvious damage to liver and kidney function in the treatment of JIA. There was no significant difference in the effect of short-term treatment between the two groups, and no serious adverse reactions occurred in the course of treatment.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.9

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