重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白治疗银屑病关节炎30例临床分析

The Clinical Characterization of Psoriatic Arthritis Treated with Recombinant Human Tumor Necrosis Factor-α Receptor Ⅱ Fusion Protein:Clinical Analysis of 30 Cases

目的探讨注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白(益赛普)治疗银屑病关节炎的临床疗效。方法纳入2011年4月—2021年2月四川大学华西医院皮肤科使用益赛普治疗的银屑病关节炎患者共30例。回顾性收集患者的人口统计学数据、临床数据、检验检查结果等。结果本研究共纳入30例银屑病关节炎患者,男性患者26例(86.67%,26/30),开始使用益赛普治疗时患者平均年龄为(44.96±11.50)岁。29例(96.67%,29/30)患者未经生物制剂治疗。既往治疗以传统治疗为主,其中使用甲氨蝶呤治疗共计24例(80.00%,24/30)。治疗过程中15例(50.00%,15/30)患者联合甲氨蝶呤治疗。8例患者在基线及治疗后3~6个月完善了临床评估及关节超声。其中7例患者在治疗后临床评估疾病活动度有明显改善,达到美国风湿学会标准所定义的关节疼痛、肿胀数量减少20%、50%以及70%(American College of Rheumatology 20/50/70 criteria,ACR 20/50/70),其中4例患者达到ACR70,2例患者达到ACR50,1例患者达到ACR20。该7例患者的关节超声表现中滑膜增厚及血流信号均有不同程度改善。结论本研究发现,益赛普可以快速控制银屑病关节炎,治疗3~6个月时评估发现临床评估与关节超声改善情况基本平行,关节超声能辅助临床评估,并有助于检测疾病活跃程度变化。

Objective To investigate the clinical effect of psoriatic arthritis patients treated with recombinant human tumor necrosis factor-αreceptorⅡfusion protein(Yisaipu).Methods In this study,a total of 30 patients with psoriatic arthritis treated with Yisaipufrom April 2011 to February 2021 at the department of Dermatology and Venereology,West China Hospital of Sichuan University were included.Demographic data,clinical data,results of laboratory tests and sonographic examination were collected retrospectively.Results There were 30 patients with psoriatic arthritis who received Yisaipu,26(86.67%,26/30)were male,and the mean age of patients was(44.96±11.50)years at the time of treatment initiation.Twenty-nine(96.67%,29/30)patients were bio-naïve patients.Previous treatment was mainly conventional,with a total of 24(80.00%,24/30)patients treated with methotrexate.Eight patients underwent clinical evaluation and joint ultrasound at baseline and 3-6 months after treatment.Seven of them showed significant improvement in clinical assessment of disease activity to the American College of Rheumatology 20/50/70 criteria(ACR 20/50/70)after treatment,with four patients achieving ACR 70,two patients achieving ACR 50,and one patient achieving ACR 20.These patients showed varying degrees of improvement in synovial thickening and blood flow signal on ultrasound examination.Conclusion In this study,Yisaipucan rapidly control psoriatic arthritis,and clinical assessment is largely parallel to the improvement in ultrasound when assessed after 3-6 months of treatment.Ultrasound evaluation can supplement to clinical assessment of psoriatic arthritis and detect changes in disease activity.