重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白对类风湿关节炎患者自身抗体的影响

The effect of recombinant human tumor necrosis factor receptor-Fc fusion protein on the autoantibody profile in patients with rheumatoid arthritis

目的:了解重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(益赛普)对类风湿关节炎(RA)患者血清自身抗体的影响。方法:选取24例处于活动期的RA患者,年龄28～56岁,其中女19例,男5例,病程0.5～3年。益赛普25mg皮下注射,每周2次,共治疗12周。在益赛普治疗前、后抽取患者血清,分别检测血清中类风湿因子(RF)、抗核抗体(ANA)、抗ENA抗体、抗双链DNA(ds-DNA)抗体、抗组蛋白抗体、抗心磷脂抗体(aCL)、抗中性粒细胞胞浆抗体(ANCA)等自身抗体。结果:益赛普治疗12周后,RF水平较治疗前明显下降(P<0.01);治疗后ANA、抗dsDNA抗体及抗组蛋白抗体阳性率较治疗前明显升高(P<0.05);而治疗前、后抗ENA抗体、aCL、ANCA的阳性率变化无显著性,24例RA患者中无一例出现系统性红斑狼疮样综合征。结论:RA患者使用益赛普治疗后可以出现自身抗体的变化,但没有发现患者出现系统性红斑狼疮样综合征。

Objective To investigate the effect of etanercept, a recombinant human tumor necrosis factor receptor-Fc fusion protein, on serum levels of autoantibodies in patients with rheumatoid arthritis （RA）. Methods Twenty-four patients with active RA were treated with twice-weekly subcutaneous etanercept （25 mg） for twelve weeks. Sera were collected to detect rheumatoid factor （RF）, antinuclear antibodies （ANA）, anti-extractable nuclear antigen （anti-ENA） antibodies,anti-double-stranded DNA （anti-dsDNA） antibodies, anti-histone antibodies,anticardiolipin antibodies （aCL）, and anti-neutrophil cytoplasma antibodies （ANCA）. Results The serum level of RF decreased significantly after etanercept therapy （P 〈 0.01 ）. As compared with the baseline, the positive rates of ANA, anti-dsDNA antibodies, and anti-histone antibodies increased significantly （P 〈 0.05） while those of anti-ENA antibodies, aCL, and ANCA did not differ significantly. No lupus-like syndrome was seen in all patients. Conclusion Etanercept therapy can induce the changes of autoantibodies in patients with RA and no drug-induced lupus erythematosus develops.