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目的:分析应用英夫利昔单抗(INF)治疗的类风湿关节炎(RA)患者的临床和实验等指标,筛选出可预测INF疗效的因素。方法:以应用INF治疗的40例RA患者为研究对象,收集基线和第14周的临床和实验等指标。应用聚合酶链反应一限制性片断长度分析法(PCR-RFLP)检测RA患者的肿瘤坏死因子α-308(TNFα-308)A/G的基因多态性。达到ACR50%-70%改善的的被判断为INF治疗反应好。采用Logistic回归模型筛选出可预测疗效的因素。结果:治疗14周后,携带TNF-308G/G基因型的RA患者,达到ACR20、ACR50、ACR70改善标准的患者人数的百分率分别为93%、64%和30%;A/G基因型,ACR20、ACR50、ACR70的百分率分别为60%、40%和20%。多因素Logistic回归分析显示,基线值中高DAS28评分和携带TNF-308G/G基因型的RA患者,对INF治疗反应好,其OR值分别为1.97(95%CI为1.74-3.13,P<0.01)和2.02(95%CI为1.93-3.91,P<0.01)。结论:高DAS28评分及携带TNF-308G/G基因型的RA患者对INF治疗有更好的应答。RA患者的DAS28评分及携带TNF-308G/G基因型可能可作为INF治疗RA疗效的预测指标。
OBJECTIVE: To analyze the clinical and laboratory parameters of rheumatoid arthritis (RA) patients treated with infliximab (INF) and screen out the factors that can predict the efficacy of INF. METHODS: Forty patients with RA treated with INF were enrolled in this study. Clinical and laboratory parameters were collected at baseline and 14 weeks. Polymerase chain reaction-restriction fragment length analysis (PCR-RFLP) was used to detect the gene polymorphism of tumor necrosis factor α-308 (TNFα-308) A / G in RA patients. Achieved ACR50% -70% improvement was judged to be good for INF treatment. Logistic regression model was used to screen out the predictors of efficacy. Results: After 14 weeks of treatment, the percentage of patients who achieved the criteria of improving ACR20, ACR50 and ACR70 in RA patients with TNF-308G / G genotype was 93%, 64% and 30% respectively. The A / G genotype, ACR20 The percentages of ACR50 and ACR70 were 60%, 40% and 20%, respectively. Multivariate Logistic regression analysis showed that patients with RA with high DAS28 score and TNF-308G / G genotype had a good response to INF, with ORs of 1.97 (95% CI 1.74-3.13, P <0.01) And 2.02 (95% CI 1.93-3.91, P <0.01). Conclusion: High DAS28 scores and RA patients with TNF-308G / G genotype have a better response to INF treatment. RA patients DAS28 score and carrying TNF-308G / G genotype may be used as predictors of the efficacy of INF in the treatment of RA.