英夫利昔单抗治疗幼年特发性关节炎的临床疗效及安全性分析

Clinical efficacy and safety of infliximab in treatment of juvenile idiopathic arthritis

目的:观察英夫利西单抗治疗多关节型幼年特发性关节炎患儿的短期疗效及安全性。方法:经确诊为多关节型JIA患儿26例,分别于0,2,6周给予3 mg·kg^(-1)静脉滴注英夫利西单抗,以后每隔8周按相同剂量注射1次,同时口服甲氨蝶呤(MTX)和非甾类抗炎药治疗,理疗和功能康复同步进行。分别在治疗前及治疗2,6,14,22,30周对累关节数(包括关节肿胀、疼痛、活动受限)、炎性指标ESR、CRP的变化及安全性进行。结果:26例多关节炎型JIA患儿由治疗前平均受累关节数目(7.1±2.4)个,治疗2周后,平均受累关节数目下降至(3.2±1.3)个(P<0.05),经治疗6周、14周、22周和30周后,平均受累关节数目进一步的减少,治疗30周后,大部分患儿关节症状消失;治疗前平均血沉水平为(65.5±20.6)mm·h^(-1),治疗2周后,平均血沉水平下降至(37.84±11.2)mm·h^(-1)(P<0.05),治疗6周、14周、22周和30周后,平均血沉水平进一步下降;治疗前平均CRP水平为(87.6±25.4)mg·L^(-1),治疗2周后,平均CRP水平下降至(40.2±15.2)mg·L^(-1)(P<0.05),治疗6周、14周、22周和30周时,CRP水平进一步下降(P<0.05)。治疗过程中未见严重感染及真菌、结核、慢性病毒感染的发生,未见肝肾功能损伤。结论:英夫利西单抗治疗多关节型JIA显效快,在较短的时间内可以明显缓解关节症状,并减轻机体的炎症反应,同时不良反应较少,主要表现为症状较轻的速发过敏反应,不影响本药物的继续使用,安全性较高。

OBJECTIVE To evaluate clinical efficacy and safety of infliximab in treatment of polyarticular juvenile idiopathic arthritis（JIA）.METHODS Twenty-six patients with polyarticular JIA were treated with infliximab（3 mg·kg^（-1））in week0,2and 6,and then fore every 8 weeks,plus methotrexate and nonsteroidal anti-inflammatory drugs（NSAIDs）by oral intake.Meanwhile,affected joint parameters including swollen,tenderness or limited joint functions and lab inflammatory index including CRP and ESR levels were evaluated.Transfusion reaction,liver and kidney function damage,complicated infection were recorded to evaluate safety of infliximabt.RESULTS Average number of affected joints by infliximab in these 26 polyarticular JIA patients decreased significant on week2 compared with that before treatment（P0.05）.Average number of affected joint continuously decreased in week6,14,22,30.Average ESR in these JIA patients with infliximab treatment decreased considerably on week 2（37.84±11.2）mm·h^（-1） compared with that before treatment（65.5±20.6）mm·h^（-1）（P0.05）.Average CRP level in these JIA patients with infliximab treatment decreased significantly on week 2（40.2±15.2）mg·L^（-1） compared with that before treatment（87.6±25.4）mg·L^（-1）（P0.05）.Both ESR and CRP continuously decreased on week 6,14,22,30.There was no significant side effect of infliximab treatment on liver or kidney functions.The most side effects from infliximab treatment were infusion reactions,including fever,rash,pale and other nonspecific discomfort,but all these side effects were well tolerated and no patient needed to withdraw infliximab.No complicated infections were observed in this study,and no negative cases turned to be positive.CONCLUSION Infliximab treatment against polyarticular JIA shows significant and rapid clinical effects,good tolerance,and only a few mild side effects.