CAJ | 학술논문

目的探讨双重滤过血浆置换(DFPP)治疗难治性类风湿关节炎(RA)的临床疗效.方法经两或三种改善病情的抗风湿药(DMARDs)规范治疗3～6月以上、病情不能缓解的活动性RA患者82例,随机分为DFPP组42例和非DFPP组40例.均给予柳氮磺胺吡啶+甲氨堞呤治疗;DFPP组在此治疗的基础上予以DFPP治疗.随访12～24个月.DFPP治疗结束后次日及随访结束时进行评估,通过疾病活动指标及类风湿因子、功能评估(HAQ)及美国风湿病学会推荐RA病情改善ACR标准判断临床疗效.结果 ①DFPP组ACR20、ACRS0和ACR70分别为100%、92.9%和81.0%,明显高于非DFPP组(17.5%、0、0,P<0.001),并于随访1～24个月后保持不变.②DFPP组功能评估明显改善,非DFPP组无变化,两组相比差异有统计学意义(P<0.001).③DFPP组疾病活动指标、类风湿因子明显下降,变化显著高于非DFPP组(P<0.001).结论 DFPP可迅速控制难治性RA患者的病情,明显改善功能,提高生活质量,临床疗效显著.
목적 탐토쌍중려과혈장치환(DFPP)치료난치성류풍습관절염(RA)적림상료효.방법 경량혹삼충개선병정적항풍습약(DMARDs)규범치료3～6월이상、병정불능완해적활동성RA환자82례,수궤분위DFPP조42례화비DFPP조40례.균급여류담광알필정+갑안첩령치료;DFPP조재차치료적기출상여이DFPP치료.수방12～24개월.DFPP치료결속후차일급수방결속시진행평고,통과질병활동지표급류풍습인자、공능평고(HAQ)급미국풍습병학회추천RA병정개선ACR표준판단림상료효.결과 ①DFPP조ACR20、ACRS0화ACR70분별위100%、92.9%화81.0%,명현고우비DFPP조(17.5%、0、0,P<0.001),병우수방1～24개월후보지불변.②DFPP조공능평고명현개선,비DFPP조무변화,량조상비차이유통계학의의(P<0.001).③DFPP조질병활동지표、류풍습인자명현하강,변화현저고우비DFPP조(P<0.001).결론 DFPP가신속공제난치성RA환자적병정,명현개선공능,제고생활질량,림상료효현저.
Objective To evaluate the efficacy of double filtration plasmapheresis (DFPP) in the treatment of patients with refractory rheumatoid arthritis (RA). Methods Eighty-two patients were randomly aesigned,42 to the DFPP group and 40 to the no-DFPP group. All patients previously experienced an incomplete response to 2-3 dis-ease-modifying antirheumatic drugs (DMARDs) and 1-2 nonsteroidal anti-inflammatory drugs (NSAIDs) or predni-sene. All patients received sulphasalazine (SASP,0.75 g three times daily) plus methotrexate (MTX, 10 mg orally once weekly). DFPP was performed once a week for 2-3 sessions. A total of 121 plasmapheresis procedures were per-formed in 42 patients. Control patients did not receive sham DFPP. The efficacy measures recorded one day after the final treatment and latest month in follow up for 12～24 months included the American College of Rheumatology 20% ,50% ,and 70% improvement criteria (ACR20, ACR50, and ACR70), the Health Assessment Questionnaire estimate of disability (HAQ); and the disease activity index. Results Patients in the DFPP group had ACR 20, ACR 50 and ACR 70 improvements of 100% ,92.9% and 81.0%,as compared with the patients in no-DFPP group 17.5% ,0,and 0 (P<0.001). Significant change from baseline was observed in HAQ scores in the DFPP group but not in the no-DFPP group (P<0.001). The changes from baseline in the disease activity scores were significantlygreater than in the no-DFPP group (P<0.001). Conclusion DFPP therapy significantly alters the signs and symp-toms of refractory RA. There are significant increases in physical function and improvement in quality of life.