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目的探讨英夫利昔单抗与依那西普治疗儿童幼年特发性关节炎(JIA)的近期临床疗效及副反应。方法选择2008年6月至2011年12月重庆医科大学附属儿童医院肾脏免疫科住院或门诊随访使用肿瘤坏死因子(TNF)拮抗剂治疗的JIA患儿26例,分为英夫利昔组11例和依那西普组15例。通过疾病活动性评价疾病活动性分数(DAS)28、临床非活动期标准、临床缓解(服药与未服药)标准等观察临床疗效,同时观察两种药物副反应。结果观察3～31个月,两组临床症状及实验室指标均有改善。英夫利昔组治疗3个月后C-反应蛋白(CRP)及依那西普组6个月后白细胞沉降率(ESR)较治疗前均下降;依那西普组3、12个月后关节肿胀数及3、6个月后关节压痛(或活动时疼痛)数较治疗前亦下降。两组治疗前后DAS28比较,依那西普组在3、6个月后DAS28较治疗前下降;英夫利昔组在治疗3个月时的DAS28较前下降。在治疗3、6个月时,依那西普组较英夫利昔组DAS28下降明显,短期疗效无差异(P>0.05)。除注射部位疼痛及皮疹外,两组均无明显副反应。结论英夫利昔及依那西普治疗JIA能降低患儿DAS28评分,改善JIA关节功能,两者短期疗效无差异,治疗过程中未发生严重副反应。
Objective To investigate the short-term clinical efficacy and side effects of infliximab and etanercept in children with juvenile idiopathic arthritis (JIA). Methods Twenty-six children with JIA treated with tumor necrosis factor (TNF) antagonist were enrolled in the hospital or outpatient department of Children’s Hospital of Chongqing Medical University from June 2008 to December 2011. They were divided into 11 infliximab group and Etanercept group of 15 cases. The disease activity score was used to evaluate the disease activity score (DAS) 28, clinical inactive period criteria, clinical remission (taking and not taking) criteria and so on. The clinical efficacy was observed and two side effects were observed. The results observed 3 to 31 months, two groups of clinical symptoms and laboratory indicators have improved. The leukocyte sedimentation rate (ESR) in C-reactive protein (CRP) group and etanercept group after 6 months of treatment were lower than those before treatment in infliximab group 3 months after treatment; The number of swelling and the number of joint tenderness (or pain during activity) after 3 and 6 months also decreased compared with those before treatment. Compared with DAS28 before and after treatment, DAS28 in etanercept group decreased after 3 and 6 months, and DAS28 in infliximab group decreased 3 months after treatment. At 3 and 6 months of treatment, DAS28 decreased significantly in the etanercept group compared with the infliximab group, with no difference in short-term efficacy (P> 0.05). In addition to injection site pain and skin rash, the two groups had no obvious side effects. Conclusions Infliximab and etanercept can reduce the DAS28 score and improve the joint function of JIA. There is no difference in short-term curative effect between the two. No serious side effects occurred during the treatment.