英夫利西单抗治疗类风湿关节炎的短期疗效及其与血药浓度和抗药物抗体的关联

目的：观察抗英夫利西单抗(infliximab，IFX)血药浓度、抗IFX药物抗体与IFX治疗活动性类风湿关节炎(rheumatoid arthritis，RA)短期疗效之间的关联，以期提供有效的疗效预测指标。方法：收集20例接受甲氨蝶呤(methotrexate，MTX)+来氟米特(leflunomide，LEF)+IFX治疗的活动性RA患者，观察并分析IFX给药前、治疗14周后基于C-反应蛋白(C-reactive protein，CRP)计算的28个关节的疾病活动度评分(disease activity score 28-CRP，DAS28-CRP)等各项指标，并记录不良反应发生情况。选择同期健康体检者20例为阴性对照。结果：IFX治疗14周后，根据欧洲抗风湿病联盟疗效标准将患者分为优效组、有效组和无效组。各组间IFX血药浓度、抗药物抗体阳性率及抗药物抗体滴度差异无统计学意义(P>0.05)，3组治疗前后外周血TNF-α水平差异均无统计学意义(P>0.05)。相关性分析显示ΔDAS28-CRP与患者外周血TNF-α水平、IFX血药浓度、抗IFX药物抗体滴度等无明显相关(P>0.05)。结论：IFX血药浓度、抗IFX药物抗体滴度及外周血TNF-α水平不能用作预测IFX治疗活动性RA 的短期疗效指标。

Association of short-term efficacy for infliximab in rheumatoid arthritis with plasma concentration and anti-drug antibody

Objective: To investigate the correlation between peripheral concentration of infl iximab (IFX) oranti-IFX antibody titers and short-term therapeutic eff ect of IFX in patients with active rheumatoidarthritis (RA ).Methods: Twenty patients with active RA were treated with combination of methotrexate (MTX),leflunomide (LEF) with IFX, and the clinical and laboratory index and the side effects were recorded before and after IFX treatment. Twenty healthy subjects were chosen as a control group.Results: After 14-week treatment, patients were categorized into good, moderate or no respondersaccording to EULAR remission criteria. There were no significant differences in peripheral IFXconcentration, anti-IFX antibody titers and TNF-α levels among the 3 groups, and there were nosignificant correlations among ΔDAS28-CRP, peripheral IFX concentration, anti-IFX antibodytiters and TNF-α levels.Conclusion: Peripheral IFX concentration, anti-IFX antibody titers and TNF-α levels can not beused as reliable predictive index for short-term effect of IFX in active RA.