不同类型TNF拮抗剂治疗强直性脊柱炎发生不良反应的临床分析

目的观察采用不同结构和人源化程度的肿瘤坏死因子（TNF）拮抗剂治疗强直性脊柱炎过程中不良反应的发生情况。方法收集接受TNF拮抗剂治疗的180例强直性脊柱炎患者的资料，了解不同生物结果TNF拮抗剂的分布，观察患者不良反应的发生和治疗情况。结果分别选用3种不同结构和人源化程度的TNF拮抗剂进行治疗，其中50例患者使用英夫利昔单抗（人鼠嵌合单抗，静脉给药），50例患者使用阿达木单抗（全人源化单抗，皮下注射），80例患者使用依那西普（进口和国产，均为皮下注射）。3种TNF拈抗剂治疗过程中均有不良反应发生，英夫利昔单抗、依那西普（国产）、依那两普（进口）和阿达木单抗不良反应的发生率分别为14％、13％、4％、6％；全人源化TNF拮抗剂总体安全性优于人鼠嵌合的TNF拮抗剂。结论相较于全人源化TNF拮抗剂，人鼠嵌合抗体更易诱发不良反应，可能与其免疫原性有关，在使用中必须严格观察和处理。

Clinical analysis of adverse reactions of ankylosing spondylitis patients treated by different TNF-inhibitors

Objective To study immunologic mechanisms induced by different TNF-inhibitors in ankylosing spondylitis treatment. Methods A total of 180 patients with ankylosing spondylitis received TNFc~ inhibitors were collected. Distribution of different TNF-inhibitors and adverse reactions of patients were observed. Results Three kinds of TNF- inhibitors were used. Among the patients, 50 were treated with Infliximab; 50, with Adalimumab; and 80, with Etanercept. The adverse reaction rates were 14%, 13%, 4%, and 6% in Infliximab, Etanercept （ domestic）, Etanercept （imported）, and Adalimumab, respectively. The humanized TNF-inhibitor was safer than the human-mouse chimeric TNF- inhibitor. Conclusion The human-mouse chimeric TNF-inhibitor was more likely to induce adverse reactions, which might be related to its immunogenieity.