2021 年第 1 期 第 16 卷

血清细胞因子和磁共振成像检查在英夫利西单抗治疗非全身型幼年特发性关节炎效果评估中的应用

Application of serum cytokines and magneatic resonance imaging monitoring in infliximab treatment of non-systemic juvenile idiopathic arthritis

作者：许瑛杰1赖建铭1周志轩1杨洋2黄小兰3吴凤岐1袁新宇2康闽1苏改秀1朱佳1侯俊1

英文作者：Xu Yingjie1 Lai Jianming1 Zhou Zhixuan1 Yang Yang2 Huang Xiaolan3 Wu Fengqi1 Yuan Xinyu2 Kang Min1 Su Gaixiu1 Zhu Jia1 Hou Jun1

单位：1首都儿科研究所风湿免疫科，北京100020；2首都儿科研究所放射科，北京100020；3首都儿科研究所中心实验室，北京100020

英文单位：1Department of Rheumatology and Immunology Capital Institute of Pediatrics Beijing 100020 China; 2Department of Radiology Capital Institute of Pediatrics Beijing 100020 China; 3Central Laboratory Capital Institute of Pediatrics Beijing 100020 China

关键词：幼年特发性关节炎；英夫利西单抗；细胞因子；磁共振成像

英文关键词：Juvenileidiopathicarthritis；Infliximab；Cytokines；Magneticresonanceimaging

• 摘要：

• 目的 探讨血清细胞因子和磁共振成像（MRI)检查在英夫利西单抗（IFX）治疗非全身型幼年特发性关节炎(JIA)效果评估中的应用价值。方法 选取2016年3月至2019年12月于首都儿科研究所住院的非全身型JIA患儿25例，均存在预后不良因素（包括年龄小、反复发作、多关节受累、出现骨质破坏）且常规治疗无效，予IFX治疗5次（第1、2、6、14、22周各静脉注射3~6 mg/kg），同时口服甲氨蝶呤和/或来氟米特。治疗前和用药后6、14、30周行红细胞沉降率（ESR）、C反应蛋白（CRP）和肿瘤坏死因子α（TNF-α)、白细胞介素2受体（IL-2R）、白细胞介素6（IL-6）水平检测和美国风湿病学会儿科（ACR Pedi）评分；治疗前选取症状最重的关节行MRI检查，用药后30周对同一关节行相同检查。结果 25例患儿中治疗前CRP升高8例（32.0%），ESR增快5例（20.0%）；用药后6周CRP、ESR均下降至正常范围，与治疗前比较差异均有统计学意义（均P＜0.05）；用药后14、30周维持在正常范围，均未进一步下降。25例患儿中治疗前TNF-α升高25例（100.0%），IL-2R升高10例（40.0%），IL-6升高20例（80.0%）。用药后6、14、30周 TNF-α均较治疗前升高，IL-2R均较治疗前下降（均P＜0.05），IL-6与治疗前比较差异均无统计学意义（均P＞0.05）。MRI结果显示，治疗后滑膜增生、关节积液、骨髓水肿均改善，骨质破坏和关节间隙狭窄均无改善。25例患儿用药后30周ACR Pedi 30、50、70改善率分别为92.0%（23/25）、72.0%（18/25）、60.0%（15/25）。结论 IL-2R水平和MRI检查有助于评估IFX治疗非全身型JIA的疗效。

• Objective To evaluate the significance of sersum cytokine and magneatic resonance imaging(MRI) in infliximab （IFX） treatment of non-systemic juvenile idiopathic arthritis(JIA). Methods From March 2016 to December 2019, 25 children with non-systemic JIA admitted to the Capital Institute of Pediatrics were selected. All children had poor prognostic factors (including young age, recurrent attacks, multiple joint involvement and bone destruction) and were treated with IFX for 5 times and oral methotrexate and/or leflunomide at the same time. The levels of erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP）, tumor necrosis factor-α（TNF-α）, interleukin-2 receptor（IL-2R） and IL-6 and American College of Rheumatology Pediatric （ACR Pedi） score were observed before and 6, 14, 30 weeks after treatment. The changes of MRI were compared before and 30 weeks after treatment. Results Among 25 patients, CRP level increased in 8 cases (32.0%) and ESR level increased in 5 cases (20.0%) before treatment; the levels of CRP and ESR were decreased to the normal range 6 weeks after treatment, and compared with before treatment the differences were statistically significant (both P＜0.05); after 14 weeks and 30 weeks of treatment, the levels of CRP and ESR were remained in the normal range without further decrease. Before treatment, TNF-α level increased in 25 cases (100.0%), IL-2R level increased in 10 cases (40.0%), and IL-6 level increased in 20 cases (80.0%). After 6, 14 and 30 weeks, TNF-α levels were higher and IL-2R levels were lower than before treatment(all P＜0.05). There were no significant differences in IL-6 levels between before and 6, 14 and 30 weeks after treatment (all P＞0.05). MRI results showed that synovial enhancement, joint effusion and bone marrow edema were improved after treatment, while bone destruction and joint space stenosis were not improved after treatment. The compliance rates of ACR Pedi 30, 50 and 70 in 25 patients were 92.0%(23/25), 72.0%(18/25) and 60.0%(15/25) at 30 weeks after treatment respectively. Conclusion After treatment with IFX, the  IL-2R level and MRI are helpful to assess the activity of non-systemic JIA and the efficacy of therapy.