中国实用儿科杂志

中国实用儿科杂志 ›› 2012, Vol. 27 ›› Issue (10): 770-773.

• 论著 • 上一篇    下一篇

英夫利昔与依那西普治疗儿童
幼年特发性关节炎临床对照研究

陈    新，唐雪梅，赵晓东，张    宇，时吉胜   

  1. 重庆医科大学附属儿童医院肾脏免疫科，重庆  400014
  • 出版日期:2012-10-06 发布日期:2012-09-24

Clinical observation on infliximab and etanercept in the treatment of juvenile idiopathic arthritis.

  1. CHEN Xin，TANG Xue-mei，ZHAO Xiao-dong，ZHANG Yu，SHI Ji-sheng.Children’s Hospital of Chongqing Medical University，Chongqing 400014，China
  • Online:2012-10-06 Published:2012-09-24

摘要：

目的    探讨英夫利昔单抗与依那西普治疗儿童幼年特发性关节炎（JIA）的近期临床疗效及副反应。方法    选择2008年6月至2011年12月重庆医科大学附属儿童医院肾脏免疫科住院或门诊随访使用肿瘤坏死因子（TNF）拮抗剂治疗的JIA患儿26例，分为英夫利昔组11例和依那西普组15例。通过疾病活动性评价疾病活动性分数（DAS）28、临床非活动期标准、临床缓解（服药与未服药）标准等观察临床疗效，同时观察两种药物副反应。结果  观察3～31个月，两组临床症状及实验室指标均有改善。英夫利昔组治疗3个月后C-反应蛋白（CRP）及依那西普组6个月后白细胞沉降率（ESR）较治疗前均下降；依那西普组3、12个月后关节肿胀数及3、6个月后关节压痛（或活动时疼痛）数较治疗前亦下降。两组治疗前后DAS28比较，依那西普组在3、6个月后DAS28较治疗前下降；英夫利昔组在治疗3个月时的DAS28较前下降。在治疗3、6个月时，依那西普组较英夫利昔组DAS28下降明显，短期疗效无差异（P＞0.05）。除注射部位疼痛及皮疹外，两组均无明显副反应。结论    英夫利昔及依那西普治疗JIA能降低患儿DAS28评分，改善JIA关节功能，两者短期疗效无差异，治疗过程中未发生严重副反应。

关键词: 英夫利昔, 依那西普, 幼年特发性关节炎, 关节功能评价, 疾病活动性分数28

Abstract:

：Objective    To observe and evaluate the clinical effect and adverse effects of the infliximab and etanercept in  treating patients with juvenile idiopathic arthritis （JIA）.Methods    There were 26 patients of JIA treated with anti-TNF therapy from June 2008 to December 2011.All patients were divided into two groups， including those treated with in?iximab（11 patients） and those with etanercept（15 patients）.We assessed clinical effects by DAS28，inactive disease standards and clinical remission（CRM/CR）， evaluating adverse reactions of two drugs as well.Results    After a follow up of 3 to 31 months，the clinical symptoms and laboratory indexes of two groups were all improved.We have found statistical differences in CRP of infliximab at the beginning of therapy and after 3 months，in ESR of etanercept at the beginning of therapy and after 6 months，in swollen joint counts of etanercept at the beginning of therapy and after 3，12months（P＜0.05），in the numbers of tender joints （or pain with activity） of etanercept at the beginning of therapy and after 3，6 months.Our study also showed statistically signi?cant differences in DAS28 values at the beginning of therapy and after 3，6 months in etanercept，and at the beginning of therapy and after 3 months in infliximab.There was obvious decrease of DAS28 values in etanercept compared with infliximab in the treatment of 3，6 months，but infliximab group much lower than etanercept one in 12 months.We found no signi?cant differences in short term clinical effect between the two drugs（P＞0.05）.Except rushes and pain caused by injection，there were no other side effects in the two groups.Conclusion Both in?iximab and etanercept can reduce DAS28 values and improve joint function in patients with JIA.We find no signi?cant differences in the responses，remissions or adverse effects between both drugs in the short term.There are no serious adverse reactions in both groups.

Key words: infliximab, etanercept, juvenile idiopathic arthritis （JIA）, joint function evaluation, DAS28