免疫净化联合免疫抑制剂治疗难治性类风湿关节炎的临床对照研究

Immunoclearance in combination with immunosuppressive in treatment of refractory rheumatoid arthritis

目的了解免疫净化联合免疫抑制剂治疗难治性类风湿关节炎(RA)的临床疗效。方法回顾性分析北京大学人民医院风湿免疫科难治性RA患者60例,均经过正规慢作用抗风湿药物和/或细胞毒药物治疗1年以上,临床症状和实验室指标未缓解。联合治疗组34例,先行免疫净化治疗1～3次,后给予来氟米特10～20mg/d治疗,对照组为单纯服用来氟米特的26例难治性RA患者,疗程均为1年。监测患者临床症状,定期检测血常规、肝功能、ESR、免疫球蛋白、类风湿因子、隐性类风湿因子、抗CCP抗体及抗AKA抗体水平,比较两组患者治疗前后各项指标的变化。结果免疫净化联合免疫抑制剂(来氟米特)治疗RA1年后患者关节炎和(或)关节痛症状有明显缓解,治疗前后比较统计学差异有显著性。治疗1年后ESR、免疫球蛋白、类风湿因子、隐性类风湿因子及抗AKA抗体阳性率较治疗前明显下降,统计学差异均有显著性。联合治疗组在3个月和12个月时上述指标的改善程度均优于对照组。另外,联合治疗对患者血液动力学无不良影响。结论免疫净化联合免疫抑制剂治疗难治性RA的疗效明显优于单纯慢作用抗风湿药物治疗,且起效快,副作用小。

Objective To investigate the efficacy of immunoclearance in combination with immunosuppressive in treatment of refractory rheumatoid arthritis. Methods We retrospectively analyzed 60 refractory rheumatoid arthritis patients. All of them had received regular disease-modifying antirheumatic drugs （DMARDs） and/ or immunosuppressives for more than one year and the symptoms were not relieved. In combination therapy group, 34 patients received 1 to 3 times of immunoclearance before leflunomide treatment （10-20mg/d）. Twenty six patients receiving leflunomide treatment only were observed as a control group. Clinical symptoms and laboratory examinations including blood routine, liver functions, immunoglobulins, rheumatoid factor （RF）, hidden rheumatoid factor （HRF）, antibody to cyclic citrullinated peptide （CCP） and anti-keratin antibody （AKA） were observed before and after treatment for one year. Results In combination therapy group after treatment for one year, arthritis symptoms improved significantly, as did erythrocyte sediment rate （ESR）, immunoglobulins, RF, HRF and AKA, when comparison was made with those before and after the treatment for 3 months. Patients in combination group had no side effects of hemodynamic disturbances. Conclusions In treatment of refractory RA, immunoclearance in combination with immunosuppressive has the advantage of faster efficacy and less side effects and is superior to DMARDs or immunosuppressive therapy.