免疫吸附治疗难治性类风湿关节炎的临床应用
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摘要
目的评价免疫吸附对于难治性类风湿关节炎的治疗效果。方法回顾性分析2014年10月~2016年12月在上海市光华中西医结合医院风湿科住院治疗的难治性类风湿关节炎患者给予免疫吸附治疗共120例的床资料。结果 120例患者炎症指标血沉(erythrocyte sedimentation rate,ESR)从治疗前(78.23±50.65)mm/h,经过治疗后下降到(3.03±2.06)mm/h,随访3个月后为(12.01±9.12)mm/h,治疗前与治疗后比较有统计学意义(t=0.394,P=0.002);C反应蛋白(C reaction protein,CRP)从治疗前(58.93±45.21)mg/L经过治疗后下降到(8.20±3.04)mg/L,随访3个月后为(18.01±12.11)mg/L,治疗前与治疗后比较有统计学意义(t=0.067,P=0.003);类风湿因子从治疗前(350.07±177.28)IU/ml经过治疗后下降到(103.22±82.06)IU/ml,随访3个月后为(230.12±145.52)IU/ml,治疗前与治疗后比较有统计学意义(t=0.033,P=0.048);120例患者免疫吸附治疗2周后,均达到ACR50或ACR70。在这些患者中1例出现胰腺炎,5例出现慢性胆囊炎急性发作,10例出现白蛋白减少经治疗都得到改善,观察期间未发生严重不良反应。结论免疫吸附治疗对于难治性类风湿关节炎的患者是有效的治疗方法,安全性较好,为难治性类风湿性关节炎患者的治疗开拓了新途径。
Objective To evaluate the therapeutic effect of immunoadsorption therapy for refractory rheumatoid arthritis. Methods Clinical data of 120 patients with refractory rheumatoid arthritis and treated with immunoadsorption therapy in the Department of Rheumatology, Shanghai Guanghua Chinese and Western Medicine Hospital from Oct. 2014 to Dec. 2016 were retrospectively analyzed. Results In the 120 patients, the inflammation indicator erythrocyte sedimentation rate(ESR) decreased from(78.23 ± 50.65)mm/h before treatment to(3.03±2.06) mm/h after treatment and(12.01±9.12) mm/h after the treatment for 3 months(t=0.394, P=0.002, comparison of ESR values before treatment and after treatment). C reaction protein(CRP)decreased from(58.93±45.21)mg/l before treatment to(8.20±3.04)mg/l after treatment and(18.01±12.11)mg/l after the treatment for 3 months(t=0.067, P=0.003, comparison of CRP values before treatment and after treatment). Rheumatoid factor decreased from(350.07±177.28) IU/ml before treatment to(103.22±82.06)IU/ml after treatment and(230.12±145.52) IU/ml after the treatment for 3 months(t=0.033, P=0.048, comparison of rheumatoid factor values before treatment and after treatment). All the 120 patients achieved ACR50 or ACR70 after immunoadsorption therapy for 2 weeks. One of the 120 patients experienced pancreatitis, 5 had acute episode of chronic cholecystitis, and 10 had hypoalbuminemia; all of these adverse reactions improved after treatment and no serious adverse reactions happened in the observation period. Conclusion Immunoadsorption therapy provides a new and effective therapeutic approach with quite better safety for refractory rheumatoid arthritis patients.
Objective To evaluate the therapeutic effect of immunoadsorption therapy for refractory rheumatoid arthritis. Methods Clinical data of 120 patients with refractory rheumatoid arthritis and treated with immunoadsorption therapy in the Department of Rheumatology, Shanghai Guanghua Chinese and Western Medicine Hospital from Oct. 2014 to Dec. 2016 were retrospectively analyzed. Results In the 120 patients, the inflammation indicator erythrocyte sedimentation rate(ESR) decreased from(78.23 ± 50.65)mm/h before treatment to(3.03±2.06) mm/h after treatment and(12.01±9.12) mm/h after the treatment for 3 months(t=0.394, P=0.002, comparison of ESR values before treatment and after treatment). C reaction protein(CRP)decreased from(58.93±45.21)mg/l before treatment to(8.20±3.04)mg/l after treatment and(18.01±12.11)mg/l after the treatment for 3 months(t=0.067, P=0.003, comparison of CRP values before treatment and after treatment). Rheumatoid factor decreased from(350.07±177.28) IU/ml before treatment to(103.22±82.06)IU/ml after treatment and(230.12±145.52) IU/ml after the treatment for 3 months(t=0.033, P=0.048, comparison of rheumatoid factor values before treatment and after treatment). All the 120 patients achieved ACR50 or ACR70 after immunoadsorption therapy for 2 weeks. One of the 120 patients experienced pancreatitis, 5 had acute episode of chronic cholecystitis, and 10 had hypoalbuminemia; all of these adverse reactions improved after treatment and no serious adverse reactions happened in the observation period. Conclusion Immunoadsorption therapy provides a new and effective therapeutic approach with quite better safety for refractory rheumatoid arthritis patients.
引文
[1]黄烽,邓小虎,张江林,等.英利昔单抗联合甲氨蝶呤治疗类风湿关节炎的随机双盲临床研究[J].中华风湿病学杂志,2006,10(9):522-526.
[2]Halilova KI,Brown EE,Morgan SL,et al.Markers of treatment response to methotrexate in rheumatoid arthritis:where do we stand?Int J Rheumatol,2012,(12):978396
[3]任杰,冯知涛,吕卓.类风湿关节炎患者外周血及滑液NKp44自然杀伤细胞的表达和临床意义探讨[J].中华风湿病学杂志,2011,3,15(3):159-163.
[4]Felson DT,Anderson JJ,Boers M,et al.American college of rhcumarology Preliminary delinition of improvement in rhcumatiod arthritis Rheum,1995,38(6):727-735.
[5]Rahman MU,Strusberg I,Geusens P,et al.Doubleblinded infliximab dose escalation in patients with rheumatoid arthritis[J].Ann Rheum Dis,2007,66(9):1233-1238.
[6]Kristensen LE,Kapetanovic MC,Gülfe A,et al.Predictors of re-sponse to anti-TNF therapy according to ACR and EULAR criteria in patients with established RA:results from the South Swedish Arthritis Treat ment Group Register[J].Rheumatology(Oxford),2008,47(4):495-499
[7]韩志武,姚国乾,李靖,等.免疫吸附治疗重症肌无力的应用体会[J].中国医师进修杂志,2009,32(10):54-56.
[8]丁雄飞.免疫吸附治疗系统性红斑狼疮近况[J].中国社区医师(医学专业),2010,12(31):8.
[9]王颖.血浆置换治疗格林巴利综合症的不良反应及护理[J].中华全科医学,2013,11(9):1443-1444.
[10]吴炜,肖玉,王志敏,等.血浆置换在神经内科自身免疫性疾病临床治疗中的不良反应分析[J].中国输血杂志,2012,25(10):1073-1076.
[11]刘明.血浆置换在神经内科自身免疫性疾病临床治疗中的不良反应[J].中国卫生产业,2013,(6):138.
[12]郝彦超,唐石磊.血浆置换在神经内科自身免疫性疾病临床治疗中的效果观察[J].中国现代药物应用,2013,7(23):73-74.
[13]Seitz M,Wirthmuelle U,Burkhard M,et al.The-308tumour necrosis factor-gene polymorphism predicts therapeutic response to TNF-αblockers in rheumatoid arthritis and spondyloarthritis patients[J].Rheumatology(Oxford),2007,46(1):93-96.
[14]Tutuncu Z,Kavanaugh A,Zvaifler N,et al.Fcgamma receptor type IIIA polymorphisms influence treatment outcomes in patients with inflammatory arthritis treated with tumor necrosis factor alpha-block-ing agents[J].Arthritis Rheum,2005,52(9):2693-2696
[15]Vander Cruyssen B,Van Looy S,Wyns B,et al.Fouryear follow-up of infliximab therapy in rheumatoid arthritis patients with long-standing refractory disease:attrition and long-term evolution of disease activity[J].Arthritis Res Ther,2006,8:R112.
[16]Schimrigk S,Faiss J,K?hler W,et al.Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption-Observational Multicenter Study with 147 patients[J].Eurpeon Neurol,2016,75(5-6):300.
[2]Halilova KI,Brown EE,Morgan SL,et al.Markers of treatment response to methotrexate in rheumatoid arthritis:where do we stand?Int J Rheumatol,2012,(12):978396
[3]任杰,冯知涛,吕卓.类风湿关节炎患者外周血及滑液NKp44自然杀伤细胞的表达和临床意义探讨[J].中华风湿病学杂志,2011,3,15(3):159-163.
[4]Felson DT,Anderson JJ,Boers M,et al.American college of rhcumarology Preliminary delinition of improvement in rhcumatiod arthritis Rheum,1995,38(6):727-735.
[5]Rahman MU,Strusberg I,Geusens P,et al.Doubleblinded infliximab dose escalation in patients with rheumatoid arthritis[J].Ann Rheum Dis,2007,66(9):1233-1238.
[6]Kristensen LE,Kapetanovic MC,Gülfe A,et al.Predictors of re-sponse to anti-TNF therapy according to ACR and EULAR criteria in patients with established RA:results from the South Swedish Arthritis Treat ment Group Register[J].Rheumatology(Oxford),2008,47(4):495-499
[7]韩志武,姚国乾,李靖,等.免疫吸附治疗重症肌无力的应用体会[J].中国医师进修杂志,2009,32(10):54-56.
[8]丁雄飞.免疫吸附治疗系统性红斑狼疮近况[J].中国社区医师(医学专业),2010,12(31):8.
[9]王颖.血浆置换治疗格林巴利综合症的不良反应及护理[J].中华全科医学,2013,11(9):1443-1444.
[10]吴炜,肖玉,王志敏,等.血浆置换在神经内科自身免疫性疾病临床治疗中的不良反应分析[J].中国输血杂志,2012,25(10):1073-1076.
[11]刘明.血浆置换在神经内科自身免疫性疾病临床治疗中的不良反应[J].中国卫生产业,2013,(6):138.
[12]郝彦超,唐石磊.血浆置换在神经内科自身免疫性疾病临床治疗中的效果观察[J].中国现代药物应用,2013,7(23):73-74.
[13]Seitz M,Wirthmuelle U,Burkhard M,et al.The-308tumour necrosis factor-gene polymorphism predicts therapeutic response to TNF-αblockers in rheumatoid arthritis and spondyloarthritis patients[J].Rheumatology(Oxford),2007,46(1):93-96.
[14]Tutuncu Z,Kavanaugh A,Zvaifler N,et al.Fcgamma receptor type IIIA polymorphisms influence treatment outcomes in patients with inflammatory arthritis treated with tumor necrosis factor alpha-block-ing agents[J].Arthritis Rheum,2005,52(9):2693-2696
[15]Vander Cruyssen B,Van Looy S,Wyns B,et al.Fouryear follow-up of infliximab therapy in rheumatoid arthritis patients with long-standing refractory disease:attrition and long-term evolution of disease activity[J].Arthritis Res Ther,2006,8:R112.
[16]Schimrigk S,Faiss J,K?hler W,et al.Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption-Observational Multicenter Study with 147 patients[J].Eurpeon Neurol,2016,75(5-6):300.