[短程小剂量益赛普治疗与附着点炎症相关的幼年特发性关节炎疗效分析] 急性化脓性炎症的早期进行大剂量

　　[摘要] 目的 交流短期小剂量使用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白（益赛普）与甲氨蝶呤联合治疗与附着点炎症相关的幼年特发性关节炎（enthesitis related juvenile idiopathic arthritis，ERA）的临床经验。 方法 将42例患者随机分为实验组和对照组，各21例。实验组给予益赛普皮下注射治疗12周，每周2次，每次12.5 mg，同时给予甲氨蝶呤（5～10 mg/周）。对照组给予甲氨蝶呤（剂量及方法同实验组）、柳氮磺吡啶（0.5～1.5 g/d）、尼美舒利（0.1～0.2 g/d），疗程12周。随时观察并记录治疗过程中的任何不良事件，在0、1、2、4、8、12周评估医患双方的VAS评分、关节肿胀数、附着点炎数，检测血常规、红细胞沉降率（ESR）、C反应蛋白、肝肾功能等。 结果 实验组和对照组的指标均较入组时有明显改善，差异有统计学意义（P ＜ 0.05），但实验组起效更快，与对照组比较差异有统计学意义（P ＜ 0.05）。治疗12周时两组的不良反应发生率比较差异无统计学意义（P ＞ 0.05）。 结论 短程小剂量益赛普联合甲氨蝶呤治疗ERA，较常规疗法起效更快，能有效控制病情，不增加不良反应，具有较好的安全性。
　　[关键词] 幼年特发性关节炎；药物治疗；益赛普；附着点炎
　　[中图分类号] R684.3 [文献标识码] A [文章编号] 1673-7210（2012）07（b）-0050-03
　　Clinical study on short-term treatment with Etanercept in enthesitis related juvenile idiopathic arthritis
　　MENG Deqian PAN Wenyou▲ JIANG Zhen LI Hui
　　Department of Rheumatology, the First People"s Hospital of Huai"an City Affiliated to Nanjing Medical University, Jiangsu Province, Huai"an 223300, China
　　[Abstract] Objective To discuss the experience of short-term treatment with Etanercept in enthesitis related juvenile idiopathic arthritis (ERA). Methods 42 patients were randomly divided into control group and experimental group, with 21 cases in each group. The patients in experimental group were treated with Etanercept for 12 weeks (subcutaneous injection of 12.5 mg, twice a week) and Methotrexate (5-10 mg a week). The control group was treated with Methotrexate (5-10 mg a week), Sulfasalazine (0.5-1.5 g/d), Nimesulide (0.1-0.2 g/d), for 12 weeks. The side effects were recorded. The blood routine, ESR, hepatic and renaI function was checked at 0, 1, 2, 4, 8, 12 weeks. Results After treatment for 12 weeks, a single item 100 mm VAS, the points of attachment, swelling joints, ESR, CRP were improved in both groups, there were significant differences (P ＜ 0.05). The above indexes of experimental group were improved quickly (P ＜ 0.05). There was no significant difference about the occurrence rate of side effects (P ＞ 0.05). Conclusion Short-term treatment with Etanercept and Methotrexate in ERA takes effect faster than normal treatment, and can conrtol disease effectively, without increasing adverse reactions, and is of good safety.
　　[Key words] Juvenile idiopathic arthritis; Drug treatment; Etanercept; Point of attachment
　　与附着点炎症相关的幼年特发性关节炎（enthesitis related juvenile idiopathic arthritis，ERA）是一种关节炎合并附着点炎，或关节炎或附着点炎症，伴有下列情况中至少2项：①骶髂关节压痛或炎症性腰骶部及脊柱疼痛，而不局限在颈椎；②HLA-B27阳性；③8岁以上发病的男性患儿；④家族史中一级亲属有HLA-B27相关的疾病（强直性脊柱炎，与附着点炎症相关的关节炎、色素膜炎或骶髂关节炎），应除外其他疾病。其主要表现为慢性、进行性、侵蚀性疾病。研究表明，肿瘤坏死因子α（TNF-α）在ERA的免疫发病及炎症过程中起着非常关键的作用，TNF-α拮抗剂可减轻炎症及关节破坏[1]。重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白（益赛普）是一种采用基因重组技术生产的融合蛋白，它可以特异性阻断TNF-α与细胞表面受体的相互作用。以往主要针对强直性脊柱炎进行了较多的研究，疗效可靠[2-4]，而对ERA的临床疗效、安全性的影响，研究很少，本文进行了小样本观察，现报道如下：