小剂量雷公藤总苷联合甲氨蝶呤对类风湿关节炎患者临床症状、炎性因子及关节功能的影响  

Effects of Low-dose Tripterygium Glycosides Combined with Methotrexate on Clinical Symptoms,Inflammatory Factors and Joint Function in Patients with Rheumatoid Arthritis

作　　者：陈士军 朱卫民 田培军 CHEN Shi-jun;ZHU Wei-min;TIAN Pei-jun(Department of Blood and Rheumatology,Ankang Central Hospital,Ankang,Shaanxi 725000,China)

机构地区：[1]安康市中心医院血液风湿科,陕西安康725000

出　　处：《临床误诊误治》2020年第3期52-56,共5页Clinical Misdiagnosis & Mistherapy

基　　金：陕西省自然科学基金资助项目(2017JM6036)。

摘　　要：目的探讨小剂量雷公藤总苷联合甲氨蝶呤对类风湿关节炎患者临床症状、炎性因子及关节功能的影响。方法选取2017年10月—2018年2月收治的类风湿关节炎68例,根据治疗方法的不同,分为对照组与观察组,每组各34例。对照组予甲氨蝶呤及常规治疗,观察组采用小剂量雷公藤总苷联合甲氨蝶呤及常规治疗。两组均治疗3个月。比较两组治疗前、治疗后临床症状(晨僵时间、关节疼痛程度、双手平均握力、关节压痛数及关节肿胀数)、炎性因子相关指标[白细胞介素-6(interleukin-6,IL-6)、C-反应蛋白(C-reactive protein,CRP)、类风湿因子(rheumatoid factors,RF)、红细胞沉降率(erythrocyte sedimentation rate,ESR)]、关节功能变化,记录不良反应发生情况。结果与对照组比较,观察组治疗后晨僵时间、关节压痛数、关节肿胀数减少,关节疼痛程度降低,双手平均握力升高,IL-6、ESR、CRP、RF水平降低,差异有统计学意义(P<0.05或P<0.01);与本组治疗前比较,两组治疗后晨僵时间、关节压痛数、关节肿胀数显著减少,关节疼痛程度明显降低,双手平均握力显著升高,IL-6、ESR、CRP、RF水平降低,且观察组治疗后关节功能障碍分级Ⅰ级比例升高及Ⅱ级比例降低,差异有统计学意义(P<0.05或P<0.01)。两组不良反应总发生率比较差异无统计学意义(χ2=1.308,P=0.253),且治疗过程中均未出现严重不良反应,给予对症处理后症状好转。结论小剂量雷公藤总苷联合甲氨蝶呤能更有效改善类风湿关节炎患者的临床症状、炎性因子水平及关节功能,且不良反应发生率低。Objective To investigate the effect of low-dose tripterygium glycosides combined with methotrexate on clinical symptoms,inflammatory factors and joint function in patients with rheumatoid arthritis(RA).Methods Sixty-eight patients with RA admitted from October 2017 to February 2018 were selected.According to the different treatment methods,68 patients were divided into control group and observation group,with 34 cases in each group.The control group was treated with methotrexate and conventional treatment,while the observation group was treated with low-dose tripterygium glycosides combined with methotrexate and conventional treatment.The course of treatment was three months for both groups.The clinical symptoms(time of morning stiffness,degree of joint pain,average grip strength of both hands,tender joint count and swollen joint count),inflammatory factor-related factors[interleukin-6(IL-6),C-reactive protein(CRP),rheumatoid factors(RF)],erythrocyte sedimentation rate(ESR),joint function changes between the two groups were compared before and after treatment.The occurrence of adverse reactions was recorded.Results Compared with the control group,the time of morning stiffness,tender joint count,the swollen joint count,and the degree of joint pain were reduced,while the average grip strength of both hands was increased.In addition,the levels of IL-6,ESR,CRP,and RF were reduced in the observation group after treatment,suggesting significant differences(P<0.05 or P<0.01).Compared with those in the same group before treatment,the time of morning stiffness,tender joint count,the swollen joint count,and the degree of joint pain were significantly reduced,whereas the average grip strength of both hands was significantly increased in both groups.Moreover,IL-6,ESR,CRP,and RF levels were reduced after treatment.In the observation group,the proportion of gradeⅠof joint dysfunction was increased and the proportion of gradeⅡwas decreased after treatment,and the difference was statistically significant(P<0.05 or P<0.01).Th

关 键 词：关节炎 类风湿 雷公藤总苷 甲氨蝶呤 关节痛 红细胞沉降率 类风湿因子 C反应蛋白质 白细胞介素6 

分 类 号：R593.22[医药卫生—内科学]