甲氨蝶呤联合白芍总苷治疗幼年特发性关节炎临床观察  

Clinical Observation on the Treatment of Juvenile Idiopathic Arthritis with Methotrexate Combining Total Glucosides of Peony

作　　者：岳利环[1] 林进[1] 徐立勤[1] 徐丹怡[1] YUE Li-huan LIN Jin XU Li-qin XU Dan-yi

机构地区：[1]浙江大学医学院附属第一医院,浙江杭州310003

出　　处：《风湿病与关节炎》2017年第1期18-21,共4页Rheumatism and Arthritis

摘　　要：目的:探讨甲氨蝶呤联合白芍总苷治疗幼年特发性关节炎的临床指标和炎症因子变化。方法:将60例幼年特发性关节炎患者随机分为甲氨蝶呤组、白芍总苷组、甲氨蝶呤联合白芍总苷组(联合组),每组20例。观察3组患者治疗前及治疗3,6个月后临床指标及炎症因子变化。结果:治疗6个月后,联合组临床症状、疾病活动指标(红细胞沉降率、C-反应蛋白)和临床疾病活动指数(CDAI)评分改善优于甲氨蝶呤组和白芍总苷组(P<0.05)。血清中炎症因子白细胞介素(IL)-1、IL-17、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶(MMP)-3和MMP-14水平明显下降(P<0.05),并与疾病活动评分CDAI呈正相关。同时,治疗6个月后,联合组患者的滑膜炎、骨髓水肿评分明显低于甲氨蝶呤组和白芍总苷组(P<0.05)。结论:甲氨蝶呤联合白芍总苷治疗幼年特发性关节炎明显优于单用甲氨蝶呤和单用白芍总苷。同时,外周血IL-1、IL-17、TNF-α和MMP-3、MMP-14水平可能作为幼年特发性关节炎疾病活动性的判断指标。Objective：To explore the clinical efficacy and changes of inflammatory factors of methotrexate combined with total glucosides of peony （ TGP ） in the treatment of juvenile idiopathic arthritis. Methods：Sixty cases of juvenile idiopathic arthritis patients were randomly divided into a methotrexate group,a TGP group and a combined group （ methotrexate combined with total glucosides of peony ） ,twenty cases in each. Clinical indicators and inflammatory factors of the three groups were observed respectively before treatment,three and six months after treatment.Results：After 6-month treatment,the improvement of clinical symptoms,indexes of disease activity （ erythrocyte sedimentation rate,C-reactive protein ） and clinical disease activity index （ CDAI ） score in the combined group was better than that in the methotrexate group and the TGP group （ P 〈 0.05 ） . IL-1,IL-17,TNF-α,MMP-3 and MMP-14 in the serum significantly decreased （P 〈 0.05 ） ,positively correlated with CDAI score.At the same time,after 6 months of treatment,the scores of synovitis and bone marrow edema of the combined group were significantly lower than those in the methotrexate group and TGP group （ P 〈 0.05 ） . Conclusion：TGP combined with methotrexate in treatment of juvenile idiopathic arthritis is better than the single use of methotrexate or TGEAt the same time,the levels of IL-1,IL-17,TNF-α,MMP-3 and MMP-14 in peripheral blood may be used as a marker for the judgment of the activity of juvenile idiopathic arthritis.

关 键 词：幼年特发性关节炎 关节炎 类风湿 甲氨蝶呤 白芍总苷 临床疗效 

分 类 号：R725.9[医药卫生—儿科]