依那西普治疗非全身型幼年特发性关节炎的近期疗效及安全性观察

目的观察依那西普治疗非全身型幼年特发性关节炎的疗效和安全性。方法对30例非全身型幼年特发性关节炎患儿皮下注射依那西普0.4 mg/(kg.次),每周2次,在治疗后1周、1个月及3个月采用ACRPedi 30/50/70评分进行疗效评估。结果治疗后1周、1月及3月时ACR Pedi 30达标率分别为16.70%、90.00%、96.67%,ACR Pedi 50达标率分别为3.30%、30.00%、66.70%,ACR Pedi 70达标率分别为0、0、16.70%(5),且无重大不良事件发生。结论依那西普治疗非全身型幼年特发性关节炎具有较好的近期疗效,在病程早期使用效果更显著,不良反应小且发生率低。     

Ӣ�������������������ƶ�ͯ �����ط��Թؽ����ٴ������о�

????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.     

托珠单抗治疗全身型幼年特发性关节炎的疗效和安全性

幼年特发性关节炎(juvenile idiopathic arthritis,JIA)是最常见的儿童风湿性疾病之一.全身型幼年特发性关节炎(systemic juvenile idiopathic arthritis,SJIA)是JIA的一个亚型,其发病机制可能有别于其他亚型.已有研究表明,IL-6、IL-18、IFN-γ而非TNF-α在SJIA中起主要作用.传统的生物制剂如TNF拮抗剂对SJIA疗效有限.托珠单抗(tocilizumab,TCZ)是一种人源化抗人白细胞介素-6受体(IL-6R)的单克隆抗体,通过抑制IL-6与跨膜型IL-6R或可溶型IL-6R的结合,阻断IL-6介导的炎性反应和关节破坏.该文就TCZ治疗SJIA的疗效和安全性研究进展作一综述.     

幼年特发性关节炎患儿丹参注射液治疗前后血D-二聚体的变化

目的 观察幼年特发性关节炎(JIA)患儿病情活动时D-二聚体的变化及丹参注射液辅助治疗的疗效.方法 将47例JIA患儿随机分配为治疗组(32例)和对照组(15例),两组按JIA常规治疗,治疗组加用丹参注射液,两组患儿在治疗前和治疗后14 d测定D-二聚体、血沉(ESR)、C反应蛋白(CRP),结合临床疗效评估结果进行比较.结果 JIA患儿病情活动时D-二聚体增高,与治疗前比较,治疗后D-二聚体、ESR、CRP同步下降,差异有统计学意义(P<0.01;P<0.05);治疗组D-二聚体降低程度较对照组明显,差异有统计学意义(P<0.05);治疗组临床有效率(59.4%)与对照组(26.7%)比较,差异有统计学意义(X2=4.372,P<0.05).结论 D-二聚体可作为JIA病情活动指标之一;丹参注射液可辅助治疗JIA,改善微循环和机体状态.     

幼年特发性关节炎患儿外周血Th细胞亚群变化

目的探讨幼年特发性关节炎(JIA)患儿外周血CD4 T淋巴细胞及其亚群CD4 CD45RA 、CD4 CD45RO 的表达及其临床意义。方法采用免疫荧光标记技术和流式细胞仪检测36例JIA患儿外周血CD4 T淋巴细胞及其亚群CD4 CD45RA 、CD4 CD45RO 的表达,同期检测20例年龄、性别无差异的健康儿童为对照。结果JIA患儿外周血CD4 T淋巴细胞明显低于对照组(t=2.099,P<0.05),CD4 CD45RA T淋巴细胞数与对照组比较明显降低(t=3.450,P<0.01),CD4 CD45RO T淋巴细胞数明显升高(t=3.913,P<0.01),CD4 CD45RA T/CD4 CD45RO T比值明显降低(t=4.904,P<0.01);与对照组比较,JIA各亚型(全身型、多关节型、少关节型)的CD4 CD45RO T淋巴细胞数均明显升高,CD4 CD45RA T/CD4 CD45RO T比值明显降低(P<0.01);CD4 CD45RA T淋巴细胞数与正常对照组比较在全身型中显著降低(t=4.192,P<0.01);在多关节型中明显降低(t=2.214,P<0.05);在少关节型中稍有降低,但与对照组比较差异无显著性(t=1.793,P>0.05)。结论JIA患儿的免疫功能紊乱主要表现为CD4 T淋巴细胞及其亚群CD4 CD45RA T/CD4 CD45RO T失衡,这可能在JIA发病机制中起着重要的作用。     

Risk of new-onset uveitis in patients with juvenile idiopathic arthritis treated with anti-TNFalpha agents

OBJECTIVE: To determine whether treatment with tumor necrosis factor alpha (TNFalpha)-blocking agents alters the incidence of new-onset uveitis in patients with juvenile idiopathic arthritis (JIA). STUDY DESIGN: Cohort study based on retrospective chart review. The charts of all 1109 patients with a diagnosis of JIA seen between January 1, 1996, and June 30, 2003, at our clinic were reviewed for diagnosis of uveitis and treatment with TNFalpha inhibitors. Cox regression analysis was performed with anti-TNFalpha treatment as a time-dependent covariate for risk of development of uveitis. RESULTS: We identified 70 patients treated with anti-TNFalpha without a prior diagnosis of uveitis. Two of these 70 patients (2.9%), both treated with etanercept, had development of new-onset uveitis during anti-TNFalpha therapy. One had juvenile psoriatic arthritis diagnosed 4.1 years before onset of uveitis. The other had extended oligoarticular JIA diagnosed 6.4 years before onset of uveitis. We found no statistically significant difference in the risk for development of uveitis between patients with or without anti-TNFalpha treatment. CONCLUSIONS: In our patients with JIA, anti-TNFalpha treatment did not alter the risk for development of new-onset uveitis. However, anti-TNFalpha therapy with etanercept did not prevent the development of uveitis in 2 patients.