肿瘤坏死因子抑制剂治疗难治性复发性多软骨炎的疗效并文献复习
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摘要
目的评价肿瘤坏死因子α(tumor necrosis factorα,TNF-α)抑制剂治疗难治性复发性多软骨炎(relapsing polychondritis,RP)的疗效及安全性。方法回顾性分析2007年11月至2016年7月于北京协和医院使用TNF-α抑制剂治疗的11例难治性RP患者的临床表现、实验室指标、合并用药情况,对TNF-α抑制剂的疗效做出评估。结果 11例RP患者中使用英夫利昔单抗者1例,使用TNF-α受体融合蛋白者10例,患者应用TNF-α抑制剂疗程为6~39个月,随访时间为6~58个月。患者用药后红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reaction protein,CRP)明显降低(P<0.05),1 s用力呼气量(forced expiratory volume in one second,FEV1)、1 s用力呼气量与用力肺活量比值(forced expiratory volume in one second and forced vital capacity ratio,FEV1/FVC)均有升高,但未见统计学差异。用药后7例患者病情好转,3例稳定,1例未见好转。评估TNF-α抑制剂疗效为有效10例,无效1例。11例患者均未见明显不良反应。结论 TNF-α抑制剂在难治性RP的治疗中具有良好的疗效和安全性,但还有待于进一步研究证实。
Objective To evaluate the efficacy and safety of tumor necrosis factor-α( TNF-α) inhibitors for the treatment of refractory relapsing polychondritis. Methods Retrospectively analyzed the clinical manifestations,laboratory data and medications of 11 patients with refractory RP who were treated with TNF-α inhibitors in Peking Union Medical College Hospital between 2007 and 2016. The efficacy of TNF-αinhibitors were then assessed. Results One patient was treated with infliximab,10 patients were treated with TNF-α soluble receptor fusion protein. Patients were treated with TNF-α inhibitors for 6 to 39 months,and were followed for 6 to 58 months. After the using of TNF-α inhibitors,the ESRs and CRPs were significantly decreased( P<0. 05). FEV1 s and FEV1/FVCs were increased,but the differences were not statistically significant. The Patients' and physicians' assessments indicated that the clinical condition of 7 patientswas improved,3 patients were in stable in a relatively good status,1 patient failed to response to the treatment and his disease was not controlled. The efficacy of TNF-α inhibitors was assessed as effective in 10 patients and ineffective in 1 patient. No adverse event was observed. Conclusion TNF-α inhibitors have good efficacy and safety in the treatment of refractory RP. But further investigations are required.
Objective To evaluate the efficacy and safety of tumor necrosis factor-α( TNF-α) inhibitors for the treatment of refractory relapsing polychondritis. Methods Retrospectively analyzed the clinical manifestations,laboratory data and medications of 11 patients with refractory RP who were treated with TNF-α inhibitors in Peking Union Medical College Hospital between 2007 and 2016. The efficacy of TNF-αinhibitors were then assessed. Results One patient was treated with infliximab,10 patients were treated with TNF-α soluble receptor fusion protein. Patients were treated with TNF-α inhibitors for 6 to 39 months,and were followed for 6 to 58 months. After the using of TNF-α inhibitors,the ESRs and CRPs were significantly decreased( P<0. 05). FEV1 s and FEV1/FVCs were increased,but the differences were not statistically significant. The Patients' and physicians' assessments indicated that the clinical condition of 7 patientswas improved,3 patients were in stable in a relatively good status,1 patient failed to response to the treatment and his disease was not controlled. The efficacy of TNF-α inhibitors was assessed as effective in 10 patients and ineffective in 1 patient. No adverse event was observed. Conclusion TNF-α inhibitors have good efficacy and safety in the treatment of refractory RP. But further investigations are required.
引文
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[8]史旭华,苏金梅,陈志科,等.复发性多软骨炎56例临床分析[J].中华全科医师杂志,2006,5:607-609.
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[2]Arnaud L,Mathian A,Haroche J,et al.Pathogenesis of relapsing polychondritis:a 2013 update[J].Autoimmun Rev,2014,13:90-95.
[3]Mc Adam LP,O'Hanlan MA,Bluestone R,et al.Relapsing polychondritis:prospective study of 23 patients and a review of the literature[J].Medicine(Baltimore),1976,55:193-215.
[4]Damiani JM,Levine HL.Relapsing polychondritis—report of ten cases[J].Laryngoscope,1979,89:929-946.
[5]Kemta LF,Kraus VB,Chevalier X.Biologics in relapsing polychondritis:a literature review[J].Semin Arthritis Rheum,2012,41:712-719.
[6]Vitale A,Sota J,Rigante D,et al.Relapsing polychondritis:an update on pathogenesis,clinical features,diagnostic tools,and therapeutic perspectives[J].Curr Rheumatol Rep,2016,18:3.
[7]Dion J,Costedoat-Chalumeau N,Sène D,et al.Relapsing Polychondritis Can Be Characterized by Three Different Clinical Phenotypes:Analysis of a Recent Series of 142 Patients[J].Arthritis Rheumatol,2016,68:2992-3001.
[8]史旭华,苏金梅,陈志科,等.复发性多软骨炎56例临床分析[J].中华全科医师杂志,2006,5:607-609.
[9]张海艇,王立,闫琳毅,等.复发性多软骨炎患者临床特征分析[J].中华医学杂志,2015,95:2375-2378.