摘要
目的:探讨人源化IL-6受体抗体(托珠单抗注射液)治疗全身型幼年特发性关节炎(sJIA)的临床疗效及安全性。方法:回顾性分析2015年12月—2016年11月在浙江大学医学院附属儿童医院应用托珠单抗治疗的13例sJIA患儿的临床资料,包括血常规、C反应蛋白(CRP)、红细胞沉降率(ESR)、IL-6、血清铁蛋白、美国风湿病学儿科(ACR Pedi)30/50/70/90评分、激素使用情况以及治疗期间的不良反应。结果:与治疗前比较,治疗后第3天患儿的CRP和ESR明显下降(均P<0.05);治疗后第2周血红蛋白增加和血小板减少(均P<0.05);第4周血清铁蛋白水平下降(P<0.05);白细胞在治疗后第8周时减少(P<0.05)。IL-6水平在治疗后先上升,第4周时下降,但与治疗前比较差异均无统计学意义(均P>0.05)。治疗第4周ACR Pedi 30或以上达100%;第20周时,61.5%的患儿达到ACR Pedi 90和停用糖皮质激素。随访至20周,所有患儿共发生不良反应22例次,其中感染发生率占54.5%(12/22),无严重不良反应发生。结论:托珠单抗能快速控制sJIA炎症,改善疾病活动度,有助于糖皮质激素的顺利减量及停药,且安全有效。
Objective: To evaluate the efficacy and safety of humanized anti-IL-6 receptor monoclonal antibody (tocilizumab) in treatment of systemic juvenile idiopathic arthritis (sJIA). Methods: Thirteen sJIA patients admitted between December 2015 and November 2016 and received tocilizumab treatment were enrolled in the study. The complete blood count (CBC) , C-reactive protein ( CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6) and ferritin levels were measured; American College of Rheumatology Pediatric (ACR Pedi)30/50/70/90 scores were assessed; and the use of glucocorticosteroid and adverse events were documented. Results: Compared with the baseline levels, the CRP and ESR at d3 were decreased (all P 〈 0. 05) ; hemoglobin was increased and platelet was decreased at week 2 ( all P 〈 0.05 ), ferritin decreased at week 4, white blood cell (WBC) decreased at week 8 after treatment with tocilizumab ( all P 〈 0. 05 ). The level of IL-6 was rising at d3 and week 2 and descending at week 4, but no significant difference was observed compared with the baseline level ( all P 〉 0.05 ). All 13 patients achieved ACR Pedi 30 remission at week 4, 61.5% achieved ACR Pedi 90 remission and glucocorticosteroids were withdrawn at week 20. Twenty two adverse events occurred, and infection accounted for 54.5% (12/22); no severe adverse reactions were observed during 20-week follow-up. Conclusion: Tocilizumab is safe and effective in treatment of sJIA, with decreasing inflammation, improving disease activity and reducing glucocorticosteroid use.
出处
《浙江大学学报(医学版)》
CAS
CSCD
北大核心
2017年第4期421-426,共6页
Journal of Zhejiang University(Medical Sciences)