艾拉莫德治疗类风湿关节炎的临床疗效及对血清学指标的影响  

Clinical Efficacy of Iguratimod in Treatment of Rheumatoid Arthritis and Its Effect on Serological Indicators

作　　者：伦晓名 沈育娟[1] 邢倩[1] 徐晓娜[2] 翟红立 LUN Xiaoming;SHEN Yujuan;XING Qian;XU Xiaona;ZHAI Hongli(Department of Immune Rheumatology,Qingdao Municipal Hospital Affiliated to Medical College of Qingdao University,Qingdao 266071,China;Central Laboratory,Qingdao Municipal Hospital Affiliated to Medical College of Qingdao University,Qingdao 266071,China)

机构地区：[1]青岛大学医学院附属青岛市市立医院免疫风湿科,山东青岛266071 [2]青岛大学医学院附属青岛市市立医院中心实验室,山东青岛266071

出　　处：《医学综述》2020年第14期2886-2890,2895,共6页Medical Recapitulate

摘　　要：目的探讨艾拉莫德对活动性类风湿关节炎(RA)合并骨量低下患者骨代谢与外周血辅助性T细胞17(Th17细胞)、调节性T细胞(Treg细胞)平衡的影响。方法选择2018年7月至2019年2月于青岛大学医学院附属青岛市市立医院东院区免疫风湿科门诊及住院治疗的60例RA合并骨量低下患者为研究对象,按照随机数字法分为对照组和观察组,每组30例。对照组给予甲氨蝶呤治疗;观察组给予甲氨蝶呤联合艾拉莫德治疗,共治疗3个月。观察并记录两组患者治疗前后骨代谢指标,包括血清1型胶原C端肽(CTX-1)、1型前胶原N端延长肽(P1NP)、核因子κB受体活化因子配体(RANKL)、骨保护素(OPG)、甲状旁腺激素(PTH)、25-羟维生素D 3[25(OH)D 3],类风湿关节炎活动度评分-28(DAS-28),血清炎症细胞因子[白细胞介素(IL)-10、IL-17、转化生长因子(TGF)-β、TGF-α]以及Th17、Treg细胞表达水平的变化情况。结果治疗前后CTX-1、P1NP、RANKL、OPG、PTH、25(OH)D 3的主效应差异有统计学意义(P<0.05),两组间CTX-1、RANKL和OPG的主效应差异有统计学意义(P<0.05);CTX-1、RANKL、OPG、25(OH)D 3的时点间与组间存在交互作用(P<0.05),两组治疗前后各指标的变化幅度不同。治疗前后DAS-28、IL-10、IL-17、TGF-β、TGF-α的主效应差异有统计学意义(P<0.05),两组间DAS-28、IL-17、TGF-α的主效应差异有统计学意义(P<0.05);DAS-28、IL-17、TGF-β、TGF-α的时点间与组间存在交互作用(P<0.05),两组治疗前后各指标的变化幅度不同。治疗前后Th17、Treg细胞表达水平的主效应差异有统计学意义(P<0.05),两组间各指标的主效应差异有统计学意义(P<0.05);Th17、Treg细胞表达水平的时点间与组间存在交互作用(P<0.05),两组治疗前后各指标的变化幅度不同。结论艾拉莫德可能通过作用于OPG/RANKL/RANK信号通路调节Th17、Treg细胞平衡发挥抗炎和骨保护作用。Objective To investigate the effect of Iguratimod on peripheral blood helper T cell 17(Th17 cell),regulatory T cell(Treg cell)balance and bone metabolism in patients with active rheumatoid arthritis(RA)complicated with low bone mass.Methods A total of 60 RA patients with low bone mass treated in the outpatient and inpatient department of Immune Rheumatology in Qingdao Municipal Hospital Affiliated to Medical College of Qingdao University from Jul.2018 to Feb.2019 were collected.They were divided into a control group and an observation group with 30 cases each according to the random number method.The control group received methotrexate therapy,and the observation group was treated with methotrexate combined with Iguratimod,for 3 months in total.Bone metabolism indexes,including C-terminal telopeptide of type 1 collagen(CTX-1),procollagen type 1 N-terminal propeptide(P1NP),receptor activator of nuclear factor-κB ligand(RANKL),osteoprotegerin(OPG),parathyroid hormone(PTH),25-hydroxyvitamin D 3[25(OH)D 3],disease activity score for rheumatoid arthritis-28(DAS-28),serum inflammatory cytokines[interleukin(IL)-10,IL-17,transforming growth factor(TGF)-β,TGF-α],and the expression levels of Th17 and Treg cell counts in the control group and observation group before and after treatment were observed and recorded respectively.Results Before and after treatment,the main effects of CTX-1,P1NP,RANKL,OPG,PTH,25(OH)D 3 were statistically significantly different(P<0.05),and the main effects of CTX-1,RANKL and OPG between the two groups were statistically significantly different(P<0.05);there were interactions in CTX-1,RANKL,OPG,25(OH)D 3 between the time points and groups(P<0.05),and the changing amplitude of each index before and after treatment were different in the two groups.The main effects of DAS-28,IL-10,IL-17,TGF-βand TGF-αbefore and after treatment were statistically significant(P<0.05),and the main effects of DAS-28,IL-17 and TGF-αbetween the two groups were statistically significantly different(P<0.05);there were

关 键 词：类风湿关节炎 艾拉莫德 辅助性T细胞17 调节性T细胞 骨代谢 

分 类 号：R593.22[医药卫生—内科学]