托珠单抗治疗中重度类风湿关节炎的临床研究

Clinical study of tocilizumab in the treatment of moderate to severe rheumatoid arthritis

目的探究托珠单抗治疗中重度类风湿关节炎的疗效,为临床合理用药治疗提供参考。方法回顾性分析我院风湿免疫科2016年1月1日至2018年8月1日收治的30例应用托珠单抗治疗类风湿关节炎的患者的情况,观察、比较患者治疗前后临床症状、体征和实验室检查等情况。结果治疗后,患者的血红蛋白、25-OH ViTD升高,血小板、白细胞计数、D-二聚体降低,病情活动性较治疗前改善。30例患者中出现局部注射反应1例,2 d内可自动消失。发生肝酶异常(未超过正常值上限2倍)2例,停药后复查正常。未出现严重感染、胃肠道症状及脑缺血发作或中风等不良反应。结论托珠单抗能有效改善中重度类风湿患者的炎症反应,改善贫血,改善维生素D缺乏,降低血小板和白细胞,改善凝血,改善患者临床症状和预后。

Objective To explore the efficacy of tocilizumab in the treatment of moderate to severe rheumatoid arthritis and to provide reference for rational drug use in clinic.Methods The clinical symptoms,signs and laboratory examinations of 30 patients with rheumatoid arthritis treated with tocilizumab in our hospital from January 1,2016 to August 1,2018 were retrospectively analyzed.Results After treatment,HGB and 25-OH ViTD increased,platelet count,white blood cell count and D-dimer decreased,and disease activity improved compared with before treatment.Local injection reaction occurred in 1 of 30 patients and disappeared within 2 days.Liver enzyme abnormality occurred in 2 cases(not exceeding the upper limit of normal value by 2 times).After withdrawal of the drug,the patients were reexamined as normal.No serious infection,gastrointestinal symptoms,cerebral ischemia attack or stroke occurred.Conclusion Tocilizumab can effectively improve the inflammatory response,anemia,and vitamin D deficiency,decrease the platelet count and white blood cell count,and improve the coagulation,clinical symptoms and prognosis in patients with moderate to severe rheumatoid arthritis.