类风湿关节炎中的HLA - DRB1分型：预测对特定治疗的反应
HLA-DRB1 typing in rheumatoid arthritis: predicting response to specific treatments.
作者信息
O'Dell J R, Nepom B S, Haire C, Gersuk V H, Gaur L, Moore G F, Drymalski W, Palmer W, Eckhoff P J, Klassen L W, Wees S, Thiele G, Nepom G T
机构信息
Department of Internal Medicine, University of Nebraska Medical Center (UNMC), USA.
出版信息
Ann Rheum Dis. 1998 Apr;57(4):209-13. doi: 10.1136/ard.57.4.209.
OBJECTIVE
To determine the predictive value of shared epitope alleles for response to treatment in patients with rheumatoid arthritis.
METHODS
Patients from our previously published triple DMARD study were tested for the presence of shared epitope alleles (DRB1 *0401, 0404/0408, 0405, 0101, 1001, and 1402). Patients who were shared epitope positive were then compared with those who were negative to see if there was a differential effect on therapeutic response.
RESULTS
Shared epitope positive patients were much more likely to achieve a 50% response if treated with methotrexate-sulphasalazine-hydroxychloroquine compared with methotrexate alone (94% responders versus 32%, p < 0.0001). In contrast shared epitope negative patients did equally well regardless of treatment (88% responders for methotrexate-sulphasalazine-hydroxychloroquine versus 83% for methotrexate). Additionally, a trend toward an inverse relation of the gene dose was seen for response to methotrexate treatment (p = 0.05).
CONCLUSIONS
These data suggest that determining shared epitope status may provide clinical information useful in selecting among treatment options.
目的
确定共享表位等位基因对类风湿关节炎患者治疗反应的预测价值。
方法
对我们之前发表的三联改善病情抗风湿药研究中的患者进行共享表位等位基因（DRB1 *0401、0404/0408、0405、0101、1001和1402）检测。然后将共享表位阳性的患者与阴性患者进行比较，以观察对治疗反应是否存在差异影响。
结果
与单独使用甲氨蝶呤相比，共享表位阳性的患者若接受甲氨蝶呤-柳氮磺胺吡啶-羟氯喹治疗，更有可能实现50%的反应率（反应者分别为94%和32%，p < 0.0001）。相比之下，共享表位阴性的患者无论接受何种治疗效果相当（甲氨蝶呤-柳氮磺胺吡啶-羟氯喹治疗的反应者为88%，甲氨蝶呤治疗的反应者为83%）。此外，观察到甲氨蝶呤治疗反应与基因剂量呈负相关趋势（p = 0.05）。
结论
这些数据表明，确定共享表位状态可能为治疗方案的选择提供有用的临床信息。
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