TNF-α拮抗剂对激素联合环磷酰胺治疗类风湿关节炎合并间质性肺病疗效的影响

doi:10.3969/j.issn.1006-6233.2021.05.05

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摘要 目的: 由于免疫抑制剂治疗类风湿关节炎合并间质性肺病(RA-ILD)效果欠佳,本研究旨在探究新的治疗方案,为治疗RA-ILD提供新的治疗方向。方法: 收集58例单纯类风湿关节炎(RA-NILD)患者和30例RA-ILD患者,通过比较两组患者的红细胞沉降率(ESR),以及血清中CRP、C3、C4、RF、CCP-Ab、TNF-α、IFN-γ、TGF-β、IL-12、IL-2、IL-4、IL-13、IL-17、MCP-1、KL-6各项指标的含量,探讨各项指标与RA-ILD的发病关系。经过TNF-α拮抗剂联合激素和环磷酰胺或激素联合环磷酰胺治疗RA-ILD后,再次检测这些指标以探讨TNF-α拮抗剂治疗RA-ILD的有效性。结果: 与RA-NILD患者相比,RA-ILD患者血清中的TGF-β、TNF-α、CCP-Ab、IL-2、IL-17、KL-6和MCP-1的含量明显更高。且经TNF-α拮抗剂联合激素和环磷酰胺治疗后的患者,血清中这些指标的转阴率明显高于激素联合环磷酰胺治疗的患者。结论: TNF-α拮抗剂能够提高激素联合环磷酰胺的治疗效果,为RA-ILD患者的治疗提供新的方向。

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关键词 ： TNF-α拮抗剂, 间质性肺病, 类风湿关节炎, 泼尼松

Abstract：Objective: To explore new treatment options for rheumatoid arthritis with interstitial lung disease (RA-ILD) in consideration of the poor efficacy of immunosuppressive therapy. Methods: Comparing the erythrocyte sedimentation rate (ESR) of 58 patients with rheumatoid arthritis without interstitial lung disease (RA-NILD) and 30 patients with RA-ILD, as well as levels of C-reactive protein (CRP), C3, C4, rheumatoid factor (RF), CCP antibody (CCP-Ab), TNF-α, IFN-γ, TGF-β, IL-12, IL-2, IL-4, IL-13, IL-17, MCP-1 and KL-6 in serum, and the relationship between various indicators and the incidence of RA-ILD were explored. With TNF-α antagonist combined with prednisone and cyclophosphamide or prednisone combined with cyclophosphamide for the treatment of RA-ILD, these cytokines were tested again to explore the effectiveness of golimumab for the treatment of RA-ILD. Results: The results showed that serum levels of TGF-β, TNF-α, CCP-Ab, IL-2, IL-17, KL-6 and MCP-1 were significantly higher in patients with RA-ILD than those in patients with RA-NILD. In addition, the negative conversion rate of these indicators in serum of patients treated with TNF-α antagonist combined with prednisone and cyclophosphamide was significantly higher than that of patients treated with prednisone combined with cyclophosphamide. Conclusion: TNF-α antagonist optimizes the therapeutic effect of prednisone combined with cyclophosphamide, and provides a new direction for the treatment of RA-ILD patients.

Key words： TNF-α antagonist Interstitial lung disease Rheumatoid arthritis Prednisone

基金资助:厦门医学院呼吸疾病研究所课题,(编号:NO.HXJB-11)

通讯作者: 王青青

引用本文:

陈旭艳, 王青青, 伊雪, 张熠, 陈永铨, 范薇, 黄金梅, 陈金, 董志高, 肖萍萍. TNF-α拮抗剂对激素联合环磷酰胺治疗类风湿关节炎合并间质性肺病疗效的影响[J]. 河北医学, 2021, 27(5): 723-727.
CHEN Xuyan, WANG Qingqing, et al. The Influence of TNF-α Antagonist on the Curative Effect of Hormone Combined with Cyclophosphamide in the Treatment of Rheumatoid Arthritis with Interstitial Lung Disease. HeBei Med, 2021, 27(5): 723-727.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.05.05 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I5/723

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