益赛普治疗类风湿关节炎伴冠心病的临床疗效

Clinical Curative Effect of Etanercept on Rheumatoid Arthritis Complicated with Coronary Heart Disease

目的观察TNFα拮抗剂益赛普治疗类风湿关节炎(Rheumatoid arthritis,RA)伴冠心病的临床疗效。方法选取60例确诊为活动期RA并发冠心病患者,随机分为慢作用药物组(30例,接受慢作用药物治疗,并在整个观察期内保持不变)和益赛普组(30例,在原慢作用药物治疗基础上皮下注射益赛普,每次25 mg,每周2次,持续3个月)。分别于治疗前及治疗12个月后采血,应用全自动荧光偏振免疫分析法测定血清同型半胱氨酸(Homocysteine,HCY)水平;评价临床疗效;经胸超声心动图测定冠状动脉血流储备(Coronary flow reserve,CFR);应用高分辨率B超对所有观察对象的肱动脉进行扫查,测定肱动脉内皮依赖性血管舒张率(Flow-mediated dilation rate,FMD);并记录12个月内发生的心血管疾病、不良反应以及肝肾功能的变化。结果益赛普组治疗后与治疗前比较,患者的血清HCY水平显著下降(P<0.05),CFR和FMD显著升高(P<0.05);慢作用药物组治疗后与治疗前比较,HCY、CFR和FMD均有所下降,但差异无统计学意义(P>0.05);与慢作用药物组比较,经益赛普治疗后,患者血清HCY水平显著下降(P<0.05),CFR和FMD显著升高(P<0.05);益赛普组临床症状缓解有效率明显高于慢作用药物组(P<0.05);12个月内,益赛普组主要心血管疾病发生率与慢作用药物组比较明显降低(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论益赛普可以明显缓解RA患者的临床症状,延缓冠心病的进展,减少心血管危险疾病的发生。

Objective To observe the clinical curative effect on Etanercept,an antagonist of TNFα,on rheumatoid arthritis（RA） complicated with coronary heart disease.Methods Sixty patients with RA complicated with coronary heart disease were divided into slow-acting drug and Etanercept groups randomly.The 30 patients in slow-acting drug group were treated with slow-acting drug during the whole observation period,while the other 30 patients in Etanercept group were treated with slow-acting drug at first then injected s.c.with Etanercept at a dosage of 25 mg twice a week for 3 months.Serum samples were collected before and 12 months after treatment and determined for homocysteine（HCY） level by full-automatic fluorescent polarization immunoassay.The clinical curative effect was evaluated.The coronary flow reserve（CFR） was determined by transthoracic echocardiography.High-resolution type B ultrasonic examination was used for scanning of arteria brachialis to measure the endothelium-dependent arterial flow-mediated dilation rate（FMD）.The cardiovascular events,adverse reactions and changes in liver and kidney functions within 12 months were recorded.Results Compared with those before treatment,the serum HCY levels of patients in Etanercept decreased significantly（P 0.05）,while the CFR and FMD increased significantly（P 0.05）.However,in slow-acting drug group,the HCY,CFR and FMD levels after treatment decreased insignificantly as compared with those before treatment（P 0.05）.Compared with those after treatment with slow-acting drug,the serum HCY level of patients after treatment with Etanercept decreased significantly（P 0.05）,while CFR and FMD increased significantly（P 0.05）.The effective remission rate of clinical symptoms of patients in Etanercept group was significantly higher,while the occurrence rate of major cardiovascular events within 12 months was significantly lower than those in slow-acting drug group（P 0.05）.However,the adverse reaction rates in the two groups showed no significant difference（P 0.05）.Conclusion Etanercept relieved the clinical symptoms of patients with RA significantly,delayed the progress of coronary heart disease and decrease the occurrence of cardiovascular events.