【摘要】 目的:探讨托珠单抗治疗难治性全身型幼年特发性关节炎的临床疗效。方法:选取2016年9月至2017年5月湖南省儿童医院肾脏风湿科收治的难治性全身型幼年特发性关节炎患儿12例进行前瞻性自身病例对照研究。入组患儿均给予托珠单抗治疗(每次8 mg/kg或12 mg/kg,每2周静脉滴注一次),比较治疗前后血白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP)、血清铁蛋白(SF)、白细胞介素-6(IL-6)水平及激素用量并记录患儿治疗前后症状、体征的变化情况及不良反应情况。结果:共入组患儿12例,所有患儿给予托珠单抗前均有中等热度以上发热,在应用托珠单抗24～48 h后体温恢复正常,6例有关节症状的患儿治疗12周后2例症状消失,2例症状好转,2例无明显变化。在治疗前无关节症状的患儿中有2例在治疗第12周出现新的关节症状。4例患儿治疗前有皮疹,在治疗24～48 h后皮疹均消失且未反复出现。与治疗前相比,治疗12周后WBC、ESR、CRP、SF均下降,激素用量减少(P均<0. 05),而IL-6变化差异无统计学意义(P>0. 05)。4例患儿出现转氨酶升高,5例患儿出现中性粒细胞水平下降,2例患儿并发上呼吸道感染2次,所有患儿在治疗期间均无过敏及严重感染等严重不良反应发生。结论:托珠单抗治疗难治性全身型幼年特发性关节炎疗效较好,不良反应发生率低,临床应用较安全。更多还原

【Abstract】 Objective: To investigate the clinical efficacy of tocilizumab in the treatment of refractory systemic juvenile idiopathic arthritis. Methods: Twelve children with refractory systemic juvenile idiopathic arthritis admitted to the renal rheumatology department of Hunan Children’s Hospital from Sept. 2016 to May 2017 were selected for the prospective case-control study. All the enrolled children were treated with tocilizumab( 8 mg/kg or 12 mg/kg each time,intravenously every 2 weeks). Total white blood cell count( WBC),erythrocyte sedimentation rate( ESR),C-reactive protein( CRP),serum ferritin( SF),interleukin-6( IL-6) levels,and hormone consumption amount were compared,changes of symptoms and signs,and adverse drug reactions were recorded before and after treatment. Results: Twelve patients were enrolled in the study. All children had moderate or higher fever before administration of tocilizumab. And the body temperature returned to the normal level after the application of tocilizumab for 24 to 48 h. After 12 weeks of treatment for 6 children with joint symptoms,the symptoms of 2 cases disappeared,2 cases had been improved,and 2 cases had no significant changes. Two of the children without joint symptoms before treatment developed new joint symptoms after 12 weeks of treatment. Four cases had rash before treatment,and the rash disappeared after 24 to 48 h of treatment without recurrence. Compared with before treatment,after 12 weeks of treatment,WBC,ESR,CRP and SF were significantly decreased,and the hormone consumption amount was significantly lower than before treatment( P< 0. 05),and interleukin-6 levels showed no significant difference( P>0. 05). Totally 4 children showed elevated transaminase,5 children showed decreased neutrophilic granulocyte level,2 children were complicated with upper respiratory tract infection for twice,and all children had no severe adverse drug reactions such as allergy and severe infection during treatment.更多还原