托珠单抗和传统药物治疗全身型幼年特发性关节炎的疗效观察

Treatment efficacy of Tocilizumab and traditional medicine on Systemic Juvenile Idiopathic Arthritis

目的比较托珠单抗和传统药物治疗全身型幼年特发性关节炎(sJIA)的临床疗效。方法选取2018年1月-2019年1月在江西省儿童医院风湿免疫科确诊的初发活动期sJIA患儿30例,按照随机数字表法分为托珠单抗组(15例)和传统治疗组(15例)。托珠单抗组予以托珠单抗联合甲氨蝶呤治疗。传统治疗组使用甲氨蝶呤、强的松和布洛芬联合治疗。比较2组患儿治疗前和治疗后4、12、24周的白细胞、血红蛋白、血小板、血沉、C反应蛋白、血清铁蛋白水平及活动性关节炎的关节数目、活动受限的关节数目;比较2组患儿治疗4、12、24周的美国风湿病学会ACRPed30、50、70改善率。结果2组患儿治疗4、12、24周后的WBC、Hb、PLT、ESR、CRP、SF水平及活动性关节炎的关节数目、活动受限的关节数目与治疗前比较均明显改善。治疗4、12、24周,托珠单抗组各项观察指标的改善均优于同期传统治疗组,差异均有统计学意义(均P<0.05);治疗4、12、24周,托珠单抗组ACRPed30、50、70改善率均明显高于同期传统治疗组,差异均有统计学意义(均P<0.05)。结论托珠单抗治疗sJIA疗效明显优于传统治疗,起效快,持续缓解率高,安全性良好。

Objective To compare clinical efficacy of tocilizumab and traditional drugs in the treatment of systemic-onset juvenile idiopathic arthritis (sJIA). Methods Thirty children with sJIA from January 2018 to January 2019 in the Department of Rheumatology and Immunology of Jiangxi Children's Hospital were randomly divided into tocilizumab group (15 cases) and traditional treatment group (15 cases). The tocilizumab group was treated with tocilizumab and methotrexate;The traditional treatment group was treated with methotrexate, prednisone and ibuprofen. After 4 weeks, 12 weeks and 24 weeks of treatment, Levels of white blood cells (WBC), hemoglobin (Hb), platelets (PLT), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum ferritin (SF),the number of joints with active arthritis and the number of joints with limited activity were compared. American College of Rheumatology(ACR) 30 improvement rate 、 ACR 50 improvement rate and ACR 70 improvement rate were compared. Results After 4 weeks, 12 weeks and 24 weeks of treatment, Levels of WBC, Hb, PLT, ESR, CRP,SF ,the number of joints with active arthritis and the number of joints with limited activity were all significantly improved than those before treatment in 2 groups.After 4 weeks, 12 weeks and 24 weeks of treatment, improvement of the observation indexes in tocilizumab group were better than those in the traditional treatment group , and the difference was statistically significant (P<0.05). ACR 30, 50 and 70 improvement rates in tocilizumab group were significantly higher than those in the traditional treatment group, and the difference was statistically significant (P<0.05).All adverse reactions were mild in tocilizumab group,including 2 cases of acute upper respiratory tract infection and 1 case of leukopenia, adverse reactions were improved after symptomatic treatment. Conclusion In the treatment of sJIA ,Tocilizumab is better than traditional treatment, with rapid onset, high sustained response rate and good safety.