免疫吸附治疗难治性类风湿关节炎的临床应用

Clinical application of immunoadsorption therapy for the treatment of refractory rheumatoid arthritis

目的评价免疫吸附对于难治性类风湿关节炎的治疗效果。方法回顾性分析2014年10月~2016年12月在上海市光华中西医结合医院风湿科住院治疗的难治性类风湿关节炎患者给予免疫吸附治疗共120例的床资料。结果 120例患者炎症指标血沉(erythrocyte sedimentation rate,ESR)从治疗前(78.23±50.65)mm/h,经过治疗后下降到(3.03±2.06)mm/h,随访3个月后为(12.01±9.12)mm/h,治疗前与治疗后比较有统计学意义(t=0.394,P=0.002);C反应蛋白(C reaction protein,CRP)从治疗前(58.93±45.21)mg/L经过治疗后下降到(8.20±3.04)mg/L,随访3个月后为(18.01±12.11)mg/L,治疗前与治疗后比较有统计学意义(t=0.067,P=0.003);类风湿因子从治疗前(350.07±177.28)IU/ml经过治疗后下降到(103.22±82.06)IU/ml,随访3个月后为(230.12±145.52)IU/ml,治疗前与治疗后比较有统计学意义(t=0.033,P=0.048);120例患者免疫吸附治疗2周后,均达到ACR50或ACR70。在这些患者中1例出现胰腺炎,5例出现慢性胆囊炎急性发作,10例出现白蛋白减少经治疗都得到改善,观察期间未发生严重不良反应。结论免疫吸附治疗对于难治性类风湿关节炎的患者是有效的治疗方法,安全性较好,为难治性类风湿性关节炎患者的治疗开拓了新途径。

Objective To evaluate the therapeutic effect of immunoadsorption therapy for refractory rheumatoid arthritis. Methods Clinical data of 120 patients with refractory rheumatoid arthritis and treated with immunoadsorption therapy in the Department of Rheumatology, Shanghai Guanghua Chinese and Western Medicine Hospital from Oct. 2014 to Dec. 2016 were retrospectively analyzed. Results In the 120 patients, the inflammation indicator erythrocyte sedimentation rate（ESR） decreased from（78.23 ± 50.65）mm/h before treatment to（3.03±2.06） mm/h after treatment and（12.01±9.12） mm/h after the treatment for 3 months（t=0.394, P=0.002, comparison of ESR values before treatment and after treatment）. C reaction protein（CRP）decreased from（58.93±45.21）mg/l before treatment to（8.20±3.04）mg/l after treatment and（18.01±12.11）mg/l after the treatment for 3 months（t=0.067, P=0.003, comparison of CRP values before treatment and after treatment）. Rheumatoid factor decreased from（350.07±177.28） IU/ml before treatment to（103.22±82.06）IU/ml after treatment and（230.12±145.52） IU/ml after the treatment for 3 months（t=0.033, P=0.048, comparison of rheumatoid factor values before treatment and after treatment）. All the 120 patients achieved ACR50 or ACR70 after immunoadsorption therapy for 2 weeks. One of the 120 patients experienced pancreatitis, 5 had acute episode of chronic cholecystitis, and 10 had hypoalbuminemia; all of these adverse reactions improved after treatment and no serious adverse reactions happened in the observation period. Conclusion Immunoadsorption therapy provides a new and effective therapeutic approach with quite better safety for refractory rheumatoid arthritis patients.