托珠单抗与英夫利西单抗在类风湿关节炎治疗中的疗效评价

Effects of tocilizumab and infliximab on the treatment of rheumatoid arthritis

目的比较托珠单抗与英夫利西单抗在治疗类风湿关节炎患者的疗效差异性。方法选取类风湿关节炎患者60例,分为托珠单抗组(30例)、英夫利西组(30例),联合甲氨蝶呤治疗,分别记录两组患者治疗前后每次的临床症状、实验室指标变化及不良反应情况,并进行分析对比。结果托珠单抗组在第2次、第3次、第4次输注时的血沉、疾病活动度评分(DAS)28评分、疼痛评分明显低于英夫利西单抗组,差异有统计学意义(t分别=2.89、4.45、3.84、2.78、5.11、4.24、2.56、2.41、2.74,P均<0.05);托珠单抗组在第3次、第4次输注时的关节压痛数明显低于英夫利西单抗组,差异有统计学意义(t分别=2.24、2.08,P均<0.05)。英夫利西单抗组中有8例患者在第4次输注时出现了DAS28评分反弹,托珠单抗组中有2例出现类似情况。英夫利西单抗组中疗效反弹的患者第4次输注DAS28评分明显高于第3次输注,差异具有统计学意义(t=3.54,P<0.05);疗效反弹的患者关节肿胀数更少、压痛痛数少、DAS28评分更低、病程更长(t分别=2.67、2.19、2.13、2.11,P均<0.05)。两组患者均无严重药物不良反应发生。结论托珠单抗能更快降低患者的炎症指标,改善患者疼痛症状,更快达到疾病低活动状态,并能较好地维持治疗效果。

Objective To compare the clinical effects of tocilizumab and infliximab on treatment of rheumatoid arthritis. Methods Totally 60 patients with rheumatoid arthritis were divided into the tocilizumab group （30 cases） and the inttiximab group （30 cases）.The drugs were administered by infusion along with stable dose of methotrexate. Clinical variables,disease activity,and adverse reactions were evaluated and compared. Results The tocilizumab group was more efficient in lowering the erythrocyte sedimentation rate,disease activity score 28 （DAS28） and VAS score at the second, third, fourth infusion points （t=2.89,4.45,3.84,2.78,5.11,4.24,2.56,2.41,2.74,P 〈0.05）. The tocilizumab treatment group was more efficient in lowering the tender joint counts at the third, fourth infusion points （t=2.24,2.08,P〈0.05）.The DAS28 score was rebounded in eight patients of the infliximab group after the last infusion. There were two cases with similar situation in tocilizumab group. The DAS28 score at the fourth infusion point was significantly higher than that at the third infusion point in eight patients of the irdliximab group（t=3.54,P〈 0.05）.There were less swollen and tender joint counts,lower DAS28 scores,longer duration of disease in the eight patients （t=2.67,2.19,2.13,2.11,P〈0.05）. No special adverse reactions occurred in the two groups.Conclusion Tocilizumab can quickly lower the inflammatory parameters,improve the pain symptom,control disease activity and maintain the efficacy.