他克莫司与甲氨蝶呤联合治疗难治性类风湿关节炎效果观察  

Clinical Efficacy of Tacrolimus Combined with Methotrexate in the Treatment of Refractory Rheumatoid Arthritis

作　　者：陈坚[1] 丁振华[1] 熊俊慧[1] 

机构地区：[1]丽水市人民医院风湿免疫科,浙江丽水323000

出　　处：《药物流行病学杂志》2018年第3期157-159,168,共4页Chinese Journal of Pharmacoepidemiology

摘　　要：目的:探讨他克莫司与甲氨蝶呤联合治疗难治性类风湿关节炎的临床效果。方法:80例难治性类风湿关节炎患者随机分为观察组和对照组,每组40例。观察组给予他克莫司与甲氨蝶呤联合治疗,对照组给予环磷酰胺与甲氨蝶呤联合治疗,两组均治疗24周。观察两组患者治疗前后关节疼痛指数、关节肿胀指数及晨僵时间的变化,采用视觉模拟评分(VAS)对患者疼痛情况进行评估;评价两组临床疗效;比较两组患者治疗前后红细胞沉降率(ESR)、C-反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、血管内皮生长因子(VEGF)等指标变化。结果:观察组总缓解率为100.00%,显著高于对照组的67.50%(P<0.05)。治疗后两组关节疼痛指数、关节肿胀指数、晨僵时间及VAS评分均较治疗前显著降低(P<0.05),且观察组各项指标均明显低于对照组(P<0.05)。两组治疗后ESR、CRP、TNF-α、VEGF均较治疗前显著降低(P<0.05),且观察组明显低于对照组(P<0.05)。结论:他克莫司与甲氨蝶呤联合治疗难治性类风湿关节炎临床疗效好,安全性高,其作用机制可能与降低患者体内炎症反应及下调VEGF水平有关。Objective： To investigate the clinical efficacy of tacrolimus combined with methotrexate in the treatment of refractory rheumatoid arthritis. Methods： 80 cases of patients with refractory rheumatoid arthritis were randomly divided into the observation group and the control group,40 cases in each group. The observation group were given tacrolimus combined with methotrexate treatment,while the control group were treated with cyclophosphamide and methotrexate treatment; the two groups were treated for 24 week to observe the changes of joint swelling index,the joint pain index and the time of morning stiffness before and after treatment. The joint visual analogue scores（ VAS score） were recorded to assess the patient＇s pain before and after treatment,as well as the laboratory indexes including erythrocyte sedimentation rate（ ESR）,C-reactive protein（ CRP）,tumor necrosis factor alpha（ TNF-alpha） and vascular endothelial growth factor（ VEGF） levels to evaluate the clinical efficacy in the two groups after treatment. Results： The total remission rate in the observation group was 100. 00%,significantly higher than that in the control group 67. 50%（ P 0. 05）. In the two groups after treatment,joint pain index,swelling index,morning stiffness and VAS scores were significantly lower than before treatment（ P 0. 05）,which in the observation group were significantly lower than the control group（ P 0. 05）. After the treatment,the two groups＇ ESR,CRP,TNF-alpha and VEGF were significantly lower than those before treatment（ P 0. 05）,which in the observation group were significantly lower（ P 0. 05）. Conclusion： Tacrolimus combined with methotrexate was effective and safe in the treatment of refractory rheumatoid arthritis. Its mechanism might be related to the reduction of inflammatory reaction in patients and down regulation of VEGF levels.

关 键 词：他克莫司 甲氨蝶呤 难治性类风湿关节炎 

分 类 号：R979.5[医药卫生—药品]