摘要
目的 探究艾拉莫德与甲氨蝶呤联合治疗类风湿关节炎(RA)合并骨质疏松患者的临床疗效,并对其血清免疫调节性细胞因子水平变化进行探究.方法 前瞻性选取2022年2月至2023年2月山西省大同市第五人民医院收治的112例RA合并骨质疏松患者,将患者按1:1随机分为试验组(n=56)和对照组(n=56).对照组接受甲氨蝶呤治疗,试验组接受艾拉莫德联合甲氨蝶呤方案治疗.记录比较患者治疗12周的疗效情况,并记录比较治疗前和治疗2、4、8、12周后时间点患者的28个关节肿胀、疼痛数量及28个关节的疾病活动度(DAS28)评分、视觉模拟评分法(VAS)评分情况,检测对比患者治疗前、治疗12周后红细胞沉降率、类风湿因子及免疫调节性细胞因子[白细胞介素(IL)-1β、IL-6、IL-8、肿瘤坏死因子α(TNF-α)]水平.结果 治疗12周后,试验组临床有效率为94.64％,高于对照组(78.57％),差异有统计学意义(P＜0.05).治疗4、8、12周后,两组28个关节肿胀数、疼痛数量、DAS28评分及VAS评分均较治疗前降低,且试验组28个关节肿胀数、疼痛数量、DAS28评分及VAS评分均低于对照组,差异均有统计学意义(P＜0.05).治疗12周后,两组的红细胞沉降率、类风湿因子均较治疗前降低,且试验组红细胞沉降率、类风湿因子分别为(20.44±5.16)mm/h、(38.46±11.02)IU/mL,均低于对照组[(28.77±6.45)mm/h、(50.26±15.23)IU/mL],差异均有统计学意义(P＜0.05).治疗12周后,两组IL-1β、IL-6、IL-8及TNF-α水平均较治疗前降低,且试验组IL-1β、IL-6、IL-8 及 TNF-α 水平分别为(6.33±0.98)、(1.79±0.45)、(0.77±0.15)、(4.22±0.36)μg/mL,均低于对照组[(10.22±1.16)、(3.11±0.78)、(0.98±0.23)、(6.78±0.39)μg/mL],差异均有统计学意义(P＜0.05).两组在治疗期间的不良反应发生情况比较,差异无统计学意义(P＞0.05).结论 艾拉莫德联合甲氨蝶呤用于RA合并骨质疏松患者的治疗在减少关节肿胀、疼痛数量和改善DAS28评分方面表现出显著效果,能显著降低VAS评分、红细胞沉降率和类风湿因子水平,调节免疫调节性细胞因子水平,且未增加不良反应的发生,是治疗此类患者的有效组合方案.
Abstract
Objective To explore the clinical efficacy of iguratimod combined with meth-otrexate in the treatment of patients with rheu-matoid arthritis(RA)complicated with osteoporosis and its effect on serum immunomodulatory cytokines.Methods A total of 112 patients with RA and osteoporosis admitted to The Fifth People's Hospital of Datong from February 2022 to 2 February 2023 were selected and randomized by 1:1 into the trial group(n=56)and the control group(n=56).The control group was treated with methotrexate,and the experimental group was treated with iguratimod combined with methotrexate.The efficacy of patients at 12 weeks of treatment was recorded,and the number of 28 joints swelling,pain and disease activity of 28 joints(DAS 28)scores and visual analogue scale(VAS)scores before and after 2,4,8,12 weeks of treatment were recorded.The levels of erythrocyte sedimentation rate,rheumatoid factor and immunomodulatory cytokines[interleukin(IL)-1 β,IL-6,IL-8,tumor necrosis factor α(TNF-α)]before and after 12 weeks of treatment were detected and compared.Results After 12 weeks of treatment,the clinical effective rate of the experimental group was 94.64％,which was higher than that of the control group(78.57％),and the difference was statistically significant(P＜0.05).After 4,8 and 12 weeks of treatment,the number of 28 joints swelling,pain,DAS28 scores and VAS scores in the two groups were lower than those before treatment,the number of 28 joints swelling,pain,DAS28 scores and VAS scores in the experimental group were lower than those in the control group,the differences were statistically significant(P＜0.05).After 12 weeks of treatment,the erythrocyte sedimentation rate and rheumatoid factor of the two groups were lower than those before treatment,and the e-rythrocyte sedimentation rate and rheumatoid factor of the experimental group were(20.44±5.16)mm/h and(38.46±11.02)IU/mL,respec-tively,which were lower than those of the control group[(28.77±6.45)mm/h,(50.26±15.23)IU/mL],the differences were statistically significant(P＜0.05).After 12 weeks of treatment,the levels of IL-1 β,IL-6,IL-8 and TNF-α in the two groups were lower than those before treatment,and the levels of IL-1 β,IL-6,IL-8 and TNF-α in the experimental group were(6.33±0.98),(1.79±0.45),(0.77±0.15)and(4.22±0.36)μg/mL,respectively,which were lower than those in the control group[(10.22±1.16),(3.11±0.78),(0.98±0.23),(6.78±0.39)μg/mL],the differences were statistically significant(P＜0.05).There was no statistically significant difference in the inci-dence of adverse reactions between the two groups during treatment(P＞0.05).Conclusion In patients with RA,reduce joint swell-ing and pain and improve the DAS 28 scores,can significantly reduce the VAS scores,blood sedimentation rate and rheumatoid factor level,and without increasing the occurrence of adverse reactions,is an effective combination for such patients.
维普
万方数据