本文選題：英夫利昔 + 依那西普��； 參考：《重慶醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：探討英夫利昔單抗（Infliximab）與依那西普（Etanercept）治療幼年特發(fā)性關(guān)節(jié)炎（JIA）的近期臨床療效及不良反應(yīng)。 方法：選擇2008年6月至2012年3月間在重慶醫(yī)科大學(xué)附屬兒童醫(yī)院免疫科住院或門診隨訪使用腫瘤壞死因子（TNF）拮抗劑治療JIA的患兒共30例，JIA的診斷與分類參照2001年國(guó)際風(fēng)濕病學(xué)聯(lián)盟（ILAR）JIA標(biāo)準(zhǔn)，分2組，英夫利昔組15例，，依那西普組15例。通過(guò)疾病活動(dòng)性評(píng)價(jià)DAS28，有效率、臨床非活動(dòng)期標(biāo)準(zhǔn)、臨床緩解（服藥/未服藥）標(biāo)準(zhǔn)等評(píng)價(jià)臨床療效；通過(guò)肝腎功、尿常規(guī)等指標(biāo)評(píng)價(jià)兩種藥物的不良反應(yīng)。用藥方法：英夫利西：3～5mg/kg/次靜脈滴注，分別于0、2、6周注射，之后每8周一次，療程最長(zhǎng)34個(gè)月；依那西普：0.4mg/kg/次（最大25mg）皮下注射，2次/周，療程最長(zhǎng)31個(gè)月，同時(shí)兩組病人均聯(lián)合甲氨蝶呤口服治療。 結(jié)果：觀察3-34月，兩組的臨床癥狀和實(shí)驗(yàn)室指標(biāo)均有改善。依那西普組6個(gè)月后CPR較治療前有明顯下降（P0.05）；英夫利昔組3、6個(gè)月和依那西普組3、6、12個(gè)月后的關(guān)節(jié)腫脹數(shù)及關(guān)節(jié)壓痛（或活動(dòng)時(shí)疼痛）數(shù)較治療前均下降明顯（P0.05）。兩組治療前后DAS28比較，依那西普組DAS28下降明顯，3、6個(gè)月后較治療前均有顯著性差異（P0.05）；英夫利昔組在治療3個(gè)月時(shí)的DAS28較前有顯著性差異（P0.05）。兩組間療效通過(guò)關(guān)節(jié)體征、輔查、DAS28評(píng)分值和DAS28變化值所評(píng)判出的治療反應(yīng)效果分別比較均無(wú)統(tǒng)計(jì)學(xué)意義（P0.05），在治療3、6個(gè)月時(shí)，依那西普組DAS28下降幅度較英夫利昔組明顯，而12個(gè)月時(shí)后者DAS28低于前者。英夫利昔組和依那西普組達(dá)到JIA臨床疾病非活動(dòng)標(biāo)準(zhǔn)分別為3例（20.0%）和6例（40.0%），達(dá)到臨床緩解（服藥）標(biāo)準(zhǔn)分別為1例（6.7%）和5例（33.3%）。依那西普組最常見(jiàn)的不良反應(yīng)主要是注射部位紅腫、瘙癢，英夫利昔組是皮疹和情緒煩躁。 結(jié)論：本研究發(fā)現(xiàn)英夫利昔及依那西普治療JIA有明顯的臨床緩解作用，能顯著降低患兒的DAS28評(píng)分，改善JIA的關(guān)節(jié)功能，用藥過(guò)程中對(duì)肝腎功能無(wú)明顯損害。二者的短期治療效果無(wú)明顯統(tǒng)計(jì)學(xué)差異，治療過(guò)程中未發(fā)生嚴(yán)重的不良反應(yīng)。
[Abstract]:Objective: to investigate the clinical efficacy and side effects of infliximab and Etanerceptin in the treatment of juvenile idiopathic arthritis (JIA). Methods: from June 2008 to March 2012, 30 children with JIA were treated with TNF- 偽 antagonist in the Department of Immunology, affiliated Children's Hospital of Chongqing Medical University. The diagnosis and classification of TNFA were compared with 2001. International Union of Rheumatology, ILARN JIA Standard, The patients were divided into 2 groups, 15 cases in the infliximab group and 15 cases in the etanisepine group. The clinical efficacy was evaluated by DAS28, effective rate, clinical inactive stage standard, clinical remission (medication / non-medication) standard, and the adverse reactions of two drugs were evaluated by liver and kidney function, urine routine and so on. Methods: Inflessie: 5 mg / kg / kg intravenously, respectively, was injected every 8 weeks for 34 months at 0 ~ 2g / kg for 6 weeks, followed by subcutaneous injection of 0.4 mg / kg / time (up to 25 mg / time) for a maximum of 31 months at the time of treatment of Ernesep: 0.4 mg / kg / time (up to 25 mg / time), the maximum duration of treatment was 31 months, and the duration of treatment was as high as 31 months. Both groups were treated with oral methotrexate. Results: the clinical symptoms and laboratory indexes of the two groups were improved in 3-34 months. The number of joint swelling and joint tenderness (or movement pain) decreased significantly after 12 months in the group of infliximab 3 months, 6 months after treatment and 6 months after treatment, and the number of joint tenderness (or pain during movement) decreased significantly after 12 months of treatment in the group of Irnathep and the group of infliximab at 3 months, 6 months after treatment and 6 months after treatment, and the number of joint tenderness (or pain during movement) decreased significantly in the group of infliximab after treatment. Compared with the two groups before and after treatment, the DAS28 of the etanerp group decreased significantly by 3%, and after 6 months there was a significant difference between the two groups (P 0.05), and the DAS28 of the infliximab group at 3 months after treatment was significantly different from that of the former group (P 0.05). The curative effect of the two groups was evaluated by joint sign, DAS28 score and DAS28 change value, respectively. There was no significant difference in the therapeutic response between the two groups. At 3,6 months after treatment, the decrease of DAS28 in the etanasip group was more obvious than that in the inflexion group. At 12 months, the DAS28 of the latter was lower than that of the former. In the inflexion group, the inactive standard of JIA was 3 cases (20.0%) and 6 cases (40.0%), and the clinical remission (drug taking) standard was 1 case (6.7g) and 5 cases (33.3g), respectively. The most common adverse effects in the Enazepine group were redness and itching at the injection site, and rash and emotional irritability in the infliximab group. Conclusion: in this study, it was found that infliximab and enazeptide could significantly reduce the DAS28 score, improve the joint function of JIA, and have no obvious damage to liver and kidney function in the treatment of JIA. There was no significant difference in the effect of short-term treatment between the two groups, and no serious adverse reactions occurred in the course of treatment.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 唐雪梅;;幼年特發(fā)性關(guān)節(jié)炎的治療[J];兒科藥學(xué)雜志;2007年04期

2 蔡宇波;張文明;曹蘭芳;;生物制劑在治療幼年特發(fā)性關(guān)節(jié)炎中的臨床應(yīng)用進(jìn)展[J];實(shí)用兒科臨床雜志;2010年09期

3 吳斌;朱寧;毛靜;梁彩霞;蔡烈鳳;張曉蓮;薛彬;張友山;;依那西普治療活動(dòng)性類風(fēng)濕關(guān)節(jié)炎臨床觀察[J];中國(guó)現(xiàn)代醫(yī)學(xué)雜志;2011年14期

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