| 吴娟洁,陶星法,吴叶清,等.阿达木单抗治疗甲氨蝶呤疗效不佳老年类风湿关节炎患者的效果及对炎症反应的影响[J].中国临床保健杂志,2025,28(5):663-667. |
| 阿达木单抗治疗甲氨蝶呤疗效不佳老年类风湿关节炎患者的效果及对炎症反应的影响 |
| Therapeutic effect of adalimumab on elderly patients with rheumatoid arthritis and poor response to MTX and the impact on inflammatory reaction |
| 投稿时间：2025-03-20 |
| DOI：10.3969/J.issn.1672-6790.2025.05.016 |
| 中文关键词: 关节炎,类风湿 阿达木单抗 甲氨蝶呤 炎症 老年人 |
| 英文关键词: Arthritis,rheumatoid Adalimumab Methotrexate Inflammation Aged 〖FL |
| 基金项目:浙江省湖州市科技局项目(2023GY37) |
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| 中文摘要: |
| 目的 探讨阿达木单抗(ADA)治疗甲氨蝶呤(MTX)疗效不佳老年类风湿关节炎(RA)患者的效果及对血清白细胞介素(IL)-4、干扰素(IFN)-γ水平的影响。方法 前瞻性随机对照研究。选取2020年4月至2023年6月湖州市第一人民医院收治的老年RA患者80例,按随机数字表法分为对照组(40例)和治疗组(40例)。对照组给予MTX联合艾拉莫德(IGU)治疗,治疗组在上述基础上加用ADA治疗。比较2组临床疗效、疾病活动性、血清炎症因子及不良反应。结果 第12周时,2组美国风湿病学会20/50/70改善应答率均高于第4、8周,且治疗组高于对照组(P＜0.05)。治疗12周时,治疗组基于红细胞沉降率的28关节疾病活动度指数、基于C反应蛋白的28关节疾病活动度指数、肿胀关节计数、压痛关节计数及患者对疼痛自我评价均降低,且治疗组低于对照组(P＜0.05)。治疗后,IFN-γ水平均降低,IL-4水平均升高；治疗组IFN-γ水平低于对照组,IL-4高于对照组(P＜0.05)。治疗组治疗期间总不良反应发生率为7.50%(3/40)与对照组总不良反应发生率为10.00%(4/40)比较,差异无统计意义(P＞0.05)。结论 ADA治疗MTX疗效不佳的老年RA患者疗效显著,可有效降低疾病活动度,减轻炎症反应程度,且安全性较好。 |
| 英文摘要: |
| Objective To investigate the clinical effect of adalimumab (ADA) in the treatment of elderly patients with rheumatoid arthritis (RA) and poor response to methotrexate (MTX),and the impact on serum interleukin-4 (IL-4) and interferon-γ (IFN-γ) levels.Methods Prospective randomized controlled study.A total of 80 elderly patients with rheumatoid arthritis (RA) admitted to Huzhou First People′s Hospital from April 2020 to June 2023 were selected,The former was treated with MTX and iguratimod (IGU),and the latter was treated with ADA on above basis.Clinical efficacy,disease activity,serum inflammatory factors,and the incidence of adverse reactions were compared between the two groups.Results In the 12th week,the American College of Rheumatology 20/50/70 improved response rate in both groups were higher than those in the 4th and 8th week.Moreover,the rates were higher in the treatment group than those in the control group (P<0.05).After 12 weeks of treatment,the Disease activity score in 28 joints based on erythrocyte sedimentation rate (DAS28-ESR),the Disease activity score in 28 joints based on C-reactive protein (Disease activity score in 28 joints based on C-reactive protein (DAS28-CRP),Swollen joint count (SJC),Tender joint count (TJC),and Patient pain self-evaluation (PPS).PPS scores of the treatment group decreased,and were lower than those of the control group (P<0.05).After treatment,serum IFN-γ level in the treatment group decreased and was lower than that in the control group.Serum IL-4 level in the treatment group increased and was higher than that in the control group (P<0.05).The total incidence rates of adverse reactions in the treatment group and the control group were 7.50% (3/40) and 10.00% (4/40),without statistical significance (P>0.05).Conclusions ADA is markedly effective in the treatment of elderly patients with RA and poor response to MTX.It can effectively reduce disease activity and alleviate inflammatory reactions,with good safety. |
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