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目的观察肿瘤坏死因子-α拮抗剂对类风湿关节炎(RA)并发慢性疾病性贫血(ACD)的疗效。方法收集2008年1月至2011年8月中国医科大学附属第一医院风湿免疫科门诊及住院的76例RA伴ACD患者。按照治疗方案的不同分为A、B两组,A组37例,为使用传统缓解病情抗风湿药(DMARDs)3个月以上并同时接受英夫利西单抗治疗的患者;B组39例,为单纯使用传统DMARDs治疗3个月以上的患者。所有患者均随访54周,并于不同观察时点记录相关指标。结果随访54周,A组患者贫血改善者35例,改善率为94.6%,其中30例贫血得到完全纠正,完全纠正率81.1%;B组患者贫血改善率为51.3%,明显低于A组(P<0.01),贫血完全纠正者12例,纠正率为30.8%,明显低于A组(P<0.01)。A组患者12～54周内的最高一次血红蛋白(Hb)质量浓度显著高于B组[(117.2±14.2)g/L对(106.7±13.4)g/L,P<0.01]。A组患者疾病活动指数(DAS28)的降低与Hb质量浓度的增加呈明显正相关关系(r=0.49,P<0.01);而在B组两者之间未呈现明显相关关系(r=0.21,P>0.05)。结论与DMARDs相比,英夫利西单抗可以更迅速、显著地改善RA相关ACD,并且贫血的改善可以作为评价英夫利西单抗有效性的一个敏感预测指标。
Objective To observe the effect of tumor necrosis factor-α antagonist on rheumatoid arthritis (RA) complicated with chronic disease anemia (ACD). Methods From January 2008 to August 2011, 76 RA patients with ACD were enrolled in the Department of Rheumatology, the First Affiliated Hospital of China Medical University. According to the different treatment options, patients in group A and B were divided into group A (n = 37) and patients in group A (n = 37) treated with conventional antidiabetic drugs (DMARDs) for more than 3 months while receiving infliximab. Simple use of traditional DMARDs for patients over 3 months. All patients were followed up for 54 weeks and relevant indicators were recorded at different observation points. Results The follow-up of 54 weeks showed that in group A, the improvement of anemia was 35 cases, the improvement rate was 94.6%, of which 30 cases of anemia were completely corrected, the complete correction rate was 81.1%; The improvement rate of anemia in group B was 51.3% P <0.01). Anemia completely corrected in 12 cases, the correction rate was 30.8%, significantly lower than the A group (P <0.01). The highest hemoglobin (Hb) concentration in group A was significantly higher than that in group B [(117.2 ± 14.2) g / L vs (106.7 ± 13.4) g / L, P <0.01] The decrease of disease activity index (DAS28) in group A was positively correlated with the increase of Hb mass concentration (r = 0.49, P <0.01), but not in group B (r = 0.21, P> 0.05). Conclusions Infliximab improves RA-related ACD more rapidly and significantly than DMARDs, and anemic improvement can be used as a sensitive predictor of the effectiveness of infliximab.