摘要
目的:了解我国类风湿关节炎(rheumatoid arthritis,RA)患者应用肿瘤坏死因子(tumor necrosis factor,TNF)抑制剂的现状以及影响其应用的因素。方法:采用多中心现况调查问卷调查的方法,记录入选者的一般情况和应用TNF抑制剂的情况,计算患者应用TNF抑制剂的费用,分析我国TNF抑制剂的应用现状及影响其应用的相关因素。结果:2009年7月至2010年11月期间,共有全国范围内的21家大型医院风湿免疫科就诊的1 095位RA患者完成问卷,其中112位患者应用了TNF抑制剂(infliximab,商品名类克或etanercept,商品名益赛普)进行治疗,占总研究人群的10.2%(其中益赛普81例,占7.4%;类克26例,占2.4%;两种制剂都用过者5例,占0.5%)。应用类克疗程<3个月及3～6个月者均为38.1%,益赛普疗程<3个月及3～6个月者分别占38.5%和25.0%。应用类克疗程<3个月、3～6个月及6～9个月者的健康评估问卷(health assessment question-naire,HAQ)评分分别为1.1、0.5、0.1,益赛普的相应评分分别为1.3、1.0、0.3。应用类克疗程<3个月、3～6个月及6～9个月的费用分别为24 525.0、69 300.0、96 800.0元,益赛普的费用分别为7 394.8、9 158.6、54 910.9元。应用类克疗程<3个月、3～6个月及6～9个月的患者的间接经济损失分别为365.6、0、158.9元,益赛普分别为2 158.4、288.5、180.1元。出现过敏和感染的比例在应用益赛普者均为3.5%,在应用类克者均为6.5%。Logistic回归分析显示,受教育程度是影响TNF抑制剂应用的主要相关因素。结论:在我国大型医院就诊的RA患者中约有10%应用过TNF抑制剂,其病情随应用TNF抑制剂的疗程延长而减轻,治疗总费用随用药疗程延长而增加,但间接经济损失随疗程延长而减少,主要不良反应为过敏和感染,受教育程度是影响其应用的主要相关因素。
Objective：To investigate the current status of tumor necrosis factor（TNF） inhibitors application in rheumatoid arthritis（RA） patients in China and to analyze the related factors.Methods： A retrospective survey was conducted in 21 hospitals from different parts of China.The patients with RA were randomly enrolled.Data of their social backgrounds,clinical conditions,usage and adverse effects of TNF inhibitors were collected.The costs of TNF inhibitors and the indirect costs of the disease were calculated.A multivariate Logistic regression analysis was performed to analyze the factors related to TNF inhibitors application.Results： In the study,1 095 RA patients from July 2009 to November 2010 were enrolled,of whom 112 had received TNF inhibitors,representing 10.2% of the total patients.The patients who received etanercept and infliximab were 7.4%（86/1 095） of the patients and 2.4%（26/1 095）,respectively.There were 0.5% of the patients（5/1 095） who had received both of the TNF inhibitors.The patients who had accepted etanercept and treatment duration for less than 3 months and 3-6 months accounted for 38.5% and 25.0% respectively,while those treated with Infliximab were 38.1%.Their health assessment question-naire（HAQ） scores were 1.1,0.5 and 0.1,corresponding to treatment duration of infliximab for less than 3,3-6 and 6-9 months and those were 1.3,1.0,0.3 corresponding to treatment duration of etanercept,respectively.Infliximab costs were RMB 24 525.0,69 300.0 and 96 800.0 Yuan and etanercept costs were RMB 7 394.8,9 158.6,54 910.9 Yuan,respectively.Indirect costs for RA patients who accepted infliximab for less than 3,3-6 and 6-9 months were RMB 365.6,0 and 158.9 Yuan and those who accepted etanercept were RMB 2 158.4,288.5 and 180.1 Yuan,respectively.Allergy and infection were the main side-effects of etanercept and both happened in 3.5% of all the patients.Liver damage happened in 2.3% of all the patients,while allergy and infection happened in 6.5% of all the patients who accepted infliximab.Logistic regression analysis showed that patients with higher education experience increased the odds of entering the TNF inhibitors group（OR： 1.292,95%CI： 1.132-1.473,P=0.000）.Conclusion： About one-tenth of RA patients in China have accepted TNF inhibitors.Higher education experience is the key factor for using TNF inhibitors.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2012年第2期182-187,共6页
Journal of Peking University:Health Sciences
基金
“十一五”国家科技支撑计划项目(2008BAI59B01)资助~~
关键词
关节炎
类风湿
肿瘤坏死因子
问卷调查
药费支出
Arthritis
rheumatoid
Tumor necrosis factor-alpha
Questionnaires
Drug costs
