甲氨蝶呤联合抗风湿药物治疗类风湿关节炎的疗效及机制研究  

Efficacy and mechanism of methotrexate combined with anti-rheumatic drugs in the treatment of rheumatoid arthritis

作　　者：张彦 ZHANG Yan(Department of Rheumatology,Ao Yang Hospital of Zhang Jia Gang,Jiangsu 215600,China)

机构地区：[1]张家港澳洋医院风湿科,江苏张家港215600

出　　处：《中国处方药》2023年第1期125-128,共4页Journal of China Prescription Drug

摘　　要：目的比较并分析不同抗风湿药物联用甲氨蝶呤的治疗方案对类风湿关节炎中的临床效果。方法选取2019年3月~2022年2月到张家港澳洋医院就诊,于风湿免疫科确诊为类风湿关节炎的患者100例,以接受甲氨蝶呤(MTX)联合羟氯喹(HCQ)治疗的患者为对照组(n=50),并以接受甲氨蝶呤联合艾拉莫德(IGU)治疗的患者为观察组(n=50)。比较并分析两组患者治疗前以及治疗12周后的临床效果、血液中的红细胞沉降率(ESR)、C反应蛋白(CRP)的改变,以及细胞因子表达水平变化。结果(1)观察组与对照组的晨僵时间,关节疼痛数和DAS28评分在治疗前差异无统计学意义(P>0.05);治疗12周后两组的晨僵时间,关节疼痛数和DAS28评分均下降(P<0.05)且观察组低于对照组(P<0.05);(2)观察组与对照组的CRP,ESR和RF的表达水平在治疗前差异无统计学意义(P>0.05);治疗12周后两组的CRP,ESR和RF均下降,且观察组下降幅度更大(P<0.05);(3)观察组与对照组之间的IL-6,TNF-α和CCL20表达水平在治疗前差异无统计学意义(P>0.05);治疗12周后两组的IL-6,TNF-α和CCL20表达水平均下降,且观察组下降幅度更大(P<0.05)。结论对于RA患者,抗风湿药物与甲氨蝶呤联合治疗发挥了良好的协同作用,不但保护患者的关节,减少疼痛,增加其活动度,下调了患者体内炎症因子的表达水平,且IGU联合MTX的治疗方案效果优于MTX联合HCQ。Objective To compare and analyze the clinical effects of different antirheumatic drugs combined with methotrexate in the treatment of rheumatoid arthritis.Methods A total of 100 patients diagnosed with rheumatoid arthritis in the rheumatology Department of Zhang Jia Gang Ao Yang Hospital from March 2019 to February 2022 were selected.The control group(n=50)were treated with methotrexate(MTX)combined with hydroxychloroquine(HCQ),the observation group were received methotrexate combined with IGU(n=50).The clinical effect,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and cytokine expression level were compared between the two groups before and 12 weeks after treatment.Results(1)There were no significant differences in joint pain numbers and DAS28 score between the observation group and the control group before treatment(P>0.05),as well as morning stiffness time.After 12 weeks of treatment,the morning stiffness time,joint pain numbers and DAS28 score of the two groups were decreased(P<0.05),and the observation group was lower than the control group(P<0.05).(2)There were no significant differences in CRP,ESR and RF expression levels between the observation group and the control group before treatment(P>0.05).After 12 weeks of treatment,CRP,ESR and RF in both groups decreased,and the decrease in the observation group was greater(P<0.05).(3)The expression levels of CCL20,TNF-αand IL-6 had no differences between the observation group and the control group before treatment(P>0.05).After 12 weeks of treatment,CCL20,TNF-αand IL-6 in both groups decreased,and the decrease in the observation group was greater.Conclusion For patients with RA,the joint treatment of anti-RA drugs and methotrexate has played a good synergistic role,not only protecting patients’joints,reducing pain,increasing their mobility,but also down-regulation of the expression level of inflammatory factors in patients and the therapeutic effect of methotrexate combined with Iguratimod is better than that of methotrexate combined with hydroxy

关 键 词：类风湿关节炎 甲氨蝶呤 羟氯喹 艾拉莫德 

分 类 号：R593.22[医药卫生—内科学]