双重血浆置换联合甲氨蝶呤治疗类风湿关节炎的疗效  

Efficacy of double filtration plasmapheresis combined with methotrexate in the treatment of rheumatoid arthritis

作　　者：赵宁 杨东星[2] 卢伟伟[1] 刘芳 于笑霞[1] 田俊阁[1] 徐萍[1] ZHAO Ning;YANG Dong-xing;LU Wei-we;LIU Fang;Yu Xiao-xia;TIAN Jun-ge;XU Ping(Department of Rheumatology,Cangzhou Traditional Chinese and Western Medicine Integrated Hospital,Cangzhou 061000,China;Department of ICU,Cangzhou Traditional Chinese and Western Medicine Integrated Hospital,Cangzhou 061000,China)

机构地区：[1]河北省沧州中西医结合医院风湿一科,沧州061000 [2]河北省沧州中西医结合医院重症医学科,沧州061000

出　　处：《中国血液净化》2020年第12期820-823,共4页Chinese Journal of Blood Purification

基　　金：沧州市重点研发计划指导项目课题:双重血浆置换联合慢作用抗风湿药治疗类风湿关节炎临床研究(183302085)。

摘　　要：目的探索双重血浆置换(double filtration plasmapheresis,DFPP)联合甲氨蝶呤(methotrexate,MTX)治疗类风湿关节炎(rheumatoid arthritis,RA)的疗效。方法2016年4月~2017年5月RA患者120例,随机分为对照组和观察组,每组60例。对照组给予甲氨蝶呤和来氟米特治疗。观察组在对照组治疗基础上给予DFPP。监测2组患者治疗前后炎症因子、Dickkopf-1(DKK1)、核因子κ-B受体活化因子配体(nuclear factorκ-B receptor activation factor ligands,RANKL)水平以及关节症状变化,并进行对比分析。结果治疗后2组患者DKK1增加(t=4.112,P<0.001),RANKL、白细胞介素6、肿瘤坏死因子α、类风湿因子、C反应蛋白、红细胞沉降率、疼痛关节数和肿胀关节数水平下降,观察组的变化程度大于对照组(t值分别为2.208,3.926,10.320,35.509,7.233,42.563,9.603,6.056;P值分别为<0.001,<0.001,<0.001,<0.001,<0.001,<0.001,<0.001,<0.001);观察组患者不良反应总数明显低于对照组(χ^(2)=3.159,P=0.047)。2组间白细胞、血小板、白蛋白差异无统计学意义(P>0.05)。结论DFPP联合MTX治疗促使血清DKK1升高,降低RANKL和炎症因子,改善临床症状。Objective To explore the efficacy of double filtration plasmapheresis(DFPP)combined with methotrexate(MTX)in the treatment of rheumatoid arthritis(RA).Methods A total of 120 RA cases treated during April 2016 to May 2017 were randomly divided into control group(n=60)and observation group(n=60).Patients in control group were treated with MTX and Leflunomide.The levels of inflammatory factors,Dickkopf-1(DKK1)and nuclear factorκ-B receptor activation factor ligand(RANKL),and joint symptoms were monitored before and after treatment in the two groups.Results After the treatment,DKK1(t=4.112,P=0.000)increased;RANKL(t=2.208,P=0.000),IL-6(t=3.926,P=0.000),TNF-α(t=10.320,P=0.000),RF(t=35.509,P=0.000),CRP(t=7.233,P=0.000),ESR(t=42.563,P=0.000),number of painful joints(t=9.603,P=0.000)and swollen joints(t=6.056,P=0.000)decreased in the two groups.The degrees of the changes were greater in observation group than in control group(P<0.05).The total number of the adverse reactions was significantly lower in observation group than in control group(χ^(2)=3.159,P=0.047).There were no significant differences in WBC,platelet and albumin between the two groups before and after treatment(P>0.05).Conclusion DFPP combined with MTX treatment increased serum DKK1,reduced RANKL and inflammatory factors,and improved clinical symptoms.

关 键 词：双重血浆置换 类风湿关节炎 DICKKOPF-1 RANKL 

分 类 号：R459.5[医药卫生—治疗学]