麦考酚酸酯治疗幼年特发性关节炎全身型的疗效分析

Clinical efficacy of mycophenolate mofetil in the treatment of systemic-onset juvenile idiopathic arthritis

摘要:

目的：评价麦考酚酸酯（mycophenolate mofetil, MMF）治疗幼年特发性关节炎全身型（system onset juvenile idiopathic arthritis, SoJIA）的临床疗效。方法：35例确诊为SoJIA并初次接受治疗的患儿随机分为3组，即传统治疗方案组（对照组），15例；MMF 1 组：传统治疗方案治疗2周后，病情无缓解，加用MMF治疗，7例；MMF 2 组：采用非甾体抗炎药+泼尼松+MMF治疗方案，13例。观察3组患儿治疗后2、4、12周的症状、体征、实验室指标及不良反应，并随访3~6个月。结果：治疗前MMF2组病程显著长于对照组，差异有统计学意义（P<0.05）。治疗2周后，与对照组相比，MMF1组和MMF2组的泼尼松用量明显减少，ESR明显减低（P<0.05）；MMF1组患儿体温高于另两组（P<0.05）。治疗4周时，与对照组比较，MMF1组泼尼松用量减少（P<0.05），ESR降低（P<0.05）；MMF2组泼尼松用量减少，体温下降并恢复至正常，WBC值降低，ESR降低，铁蛋白降低，差异均具有统计学意义（P<0.05）；MMF1和MMF2组相比，MMF2组体温更低（P<0.05）。MMF治疗组均未出现MMF用药的副作用。结论：MMF联合治疗能更好地控制SoJIA患儿病情，更快缓解其临床症状，减少联合应用的糖皮质激素药物的剂量，并有良好的安全性。

Abstract:

OBJECTIVE: To evaluate the clinical efficacy of mycophenolate mofetil (MMF) in the treatment of systemic-onset juvenile idiopathic arthritis (SoJIA). METHODS: Thirty-five patients with a confirmed diagnosis of SoJIA who had received initial treatment were randomly divided into control (n=15), MMF1 (n=7) and MMF2 groups (n=13). The control group received conventional treatment, the MMF1 group received MMF after 2 weeks of conventional treatment that had not led to remission, and the MMF2 group received combination therapy with non-steroidal anti-inflammatory drugs, prednisone and MMF. Symptoms, signs, laboratory indices, and adverse events were observed after 2, 4, and 12 weeks of treatment, and follow-up was performed for 3-6 months. RESULTS: Before treatment, the MMF2 group had a significantly longer disease course than the control group (P<0.05). After 2 weeks of treatment, the MMF1 and MMF2 groups had a significantly lower prednisone dose and erythrocyte sedimentation rate (ESR) than the control group (P<0.05). The MMF1 group had significantly higher body temperature than the other two groups (P<0.05). After 4 weeks of treatment, the MMF1 group had a significantly lower prednisone dose and ESR than the control group (P<0.05). The MMF2 group had a significantly lower prednisone dose, body temperature (recovery to normal), white blood cell count, ESR and serum ferritin concentration than the control group (P<0.05). Body temperature was significantly lower in the MMF2 group than in the MMF1 group (P<0.05). No adverse events were observed in either the MMF1 or MMF2 groups during treatment. CONCLUSONS: Combination therapy with MMF can lead to better control of the patient's condition, more rapid relief of clinical symptoms and reduced glucocorticoid dose. The therapy with MMF is safe in children.