全反式维甲酸联合缓解病情抗风湿药治疗儿童类风湿关节炎的近远期疗效

Short-and long-term efficacy of all-trans retinoic acid plus disease-modifying anti-rheumatic drugs in children with rheumatoid arthritis

目的观察全反式维甲酸联合传统缓解病情抗风湿药cDMARDs治疗儿童类风湿关节炎(RA)患者的近远期疗效。方法以2018年6月至2020年6月本院诊治的84例儿童RA病例为研究对象,随机数字表法分为cDMARDs组和维甲酸联合组,每组42例。cDMARDs组予以甲氨蝶呤与来氟米特的用药方案治疗,维甲酸联合组在cDMARDs组药物治疗基础上联合小剂量全反式维甲酸治疗。2组均于干预6个月、干预1年时进行近远期综合疗效评估,并观察2组干预前、干预6个月、干预1年时的主观疗效性指标、客观疗效性指标及影像学相关指标的改变情况。结果cDMARDs组和维甲酸联合组的近期(6个月)临床有效率(67%和71%)比较,差异无统计学意义(χ^(2)=0.716,P=0.384)。维甲酸联合组的远期(1年)临床有效率(93%)高于cDMARDs组(74%)(χ^(2)=6.982,P=0.018)。干预6个月、干预1年时,cDMARDs组和维甲酸联合组的主观疗效性指标[(关节肿胀评分、视觉模拟评分(VAS)、骨性关节炎指数评分(WOM-AC)]、客观疗效性指标[C反应蛋白(CRP)、红细胞沉降率(ESR)、辅助T细胞17/调节T细胞(Th17/Treg)]及影像学相关指标[(滑膜增生评分、骨侵蚀评分、关节积液评分、活动度28个关节疾病活动指数(DAS)28评分]均较干预前降低(P<0.05);干预6个月时,cDMARDs组和维甲酸联合组的主观疗效性指标(关节肿胀评分、关节VAS评分、关节WOM-AC评分)、客观疗效性指标(CRP、ESR、Th17/Treg)及影像学相关指标(滑膜增生评分、骨侵蚀评分、关节积液评分、活动度DAS28评分)比较差异无统计学意义(P>0.05),但干预1年时,维甲酸联合组的主观疗效性指标(客观疗效性指标及影像学相关指标低于cDMARDs组(P<0.05)。结论反式维甲酸联合cDMARDs可改善儿童RA的远期疗效,值得临床重视。

Objective To investigate the short-and long-term efficacy of all-trans retinoic acid plus clas-sical disease-modifying antirheumatic drugs(cDMARDs)in the treatment of children with rheumatoid arthritis(RA).Methods A total of 84 RA children diagnosed and treated in our hospital between June 2018 and June 2020 were recruited and were randomly divided into the cDMARDs group and the retinoic acid combination thera-py group(n=42 each).The cDMARDs group was treated with the methotrexate and leflunomide regimen,while the retinoic acid combination therapy group was treated with low-dose all-trans retinoic acid in addition to the medications in the cDMARDs group.The two groups were comprehensively evaluated for short-and long-term efficacy at 6 months and at 1 year of intervention,as well as the subjective and objective efficacy indicators,changes in imaging findings before and at 6 months and 1 year of intervention.Results There was no significant difference in the short-term(6-month)clinical response rates(67%vs 71%)between the cDMARDs group and the retinoic acid combination thereapy group(χ^(2)=0.716,P=0.384).The long-term(1-year)clinical response rate was higher in the retinoic acid combination therapy group than that in the cDMARDs group(93%vs 74%,χ^(2)=6.982,P=0.018).Either at 6 months or 1 year of intervention,improvements in subjective efficacy indicators(including scores of joint swelling,joint VAS,and joint WOM-AC),objective efficacy indicators(including CRP,ESR,and Th17/Treg)and imaging findings(scores of synovial hyperplasia,bone erosion,joint effusion,and disease activity DAS28)were noted in either group compared with baseline(P<0.05).At 6 months of intervention,the subjective efficacy indicators(including joint swelling,joint VAS,and joint WOM-AC scores),objective efficacy indicators(including CRP,ESR,and Th17/Treg)and imaging findings(synovial hyperplasia,bone erosion,joint effusion,and disease activity DAS28 scores)did not differ significantly between the cDMARDs group and retinoic acid combination therapy group(P>0.05).However,at 1 year of intervention,subjective efficacy indicators(including s joint swelling,joint VAS,and joint WOM-AC cores),objective efficacy indicators(including CRP,ESR,and Th17/Treg)and imaging findings(synovial hyperplasia,bone erosion,joint effusion,and disease activity DAS28 scores)were lower in the retinoic acid combination therapy group than those in the cDMARDs group(P<0.05).Conclusion All-trans retinoic acid plus cDMARDs can improve the long-term efficacy in children with RA,and therefore war-rants clinical attention.