雷公藤周期用药治疗育龄期女性类风湿性关节炎患者的疗效与安全性  

Efficacy and safety of cyclical medication with tripterygium wilfordii in treatment of rheumatoid arthritis in women of childbearing age

作　　者：郭静波 李亮 王晓玉 张慧锦 赵品 柳晓青 Guo Jing-bo;Li Liang;Wang Xiao-yu;Zhang Hui-jin;Zhao Pin;Liu Xiao-qing(Department of Traditional Chinese Medicine,980th Hospital of Joint Logistic Support Force,Shijiazhuang 050000,China;Department of Disease Prevention and Control,980th Hospital of Joint Logistic Support Force,Shijiazhuang 050000,China;The Second Department of Rheumatology,Yiling Hospital of Hebei Province,Shijiazhuang 050000,China;Department of Traditional Chinese Medicine,Zhengding 256 Hospital,Shijiazhuang 050800,China)

机构地区：[1]联勤保障部队第九八〇医院中医科,石家庄050000 [2]联勤保障部队第九八〇医院疾病预防控制科,石家庄050000 [3]河北以岭医院风湿病二科,石家庄050000 [4]正定二五六医院中医科,石家庄050800

出　　处：《中国药物应用与监测》2025年第1期51-55,共5页Chinese Journal of Drug Application and Monitoring

基　　金：河北省中医药管理局科研计划项目(2021213)。

摘　　要：目的探究雷公藤周期用药治疗育龄期女性类风湿性关节炎(RA)的效果、机制及安全性。方法将2021年1月至2023年10月联勤保障部队第九八〇医院中医科门诊治疗的200例育龄期女性RA患者,以随机数字表法分为4组,各50例。连续组雷公藤持续用药,1月组雷公藤间隔1月周期用药,2月组雷公藤间隔2月周期用药,3月组雷公藤间隔3月周期用药,各组育龄期女性RA患者疗程均为12个月。比较各组育龄期女性RA患者疗效、28个关节疾病活动度(DAS28)评分、血管生成因子[血管内皮生长因子(VEGF)mRNA、血管生成素2(Ang-2)]、生殖毒性及其他不良反应。结果3月组美国风湿病学会(ACR)RA治疗缓解指标ACR20、ACR50、ACR70分别为70.00%(35/50)、34.00%(17/50)、4.00%(2/50),低于1月组的84.00%(42/50)、56.00%(28/50)、24.00%(12/50)和2月组的80.00%(40/50)、52.00%(26/50)、20.00%(10/50)(χ^(2)=10.027、8.724、13.000,均P<0.05),1月组、2月组与连续组比较差异无统计学意义(均P>0.05)。3月组3、6、9、12个月后DAS28评分[分别为(6.42±2.13)分,(5.04±1.59)分,(4.40±1.31)分、(3.84±1.220)分],高于1月组[分别为(5.28±1.75)分,(3.75±1.20)分,(2.17±0.70)分、(1.88±0.61)分]、2月组[分别为(5.41±1.80)分、(3.81±1.18)分、(2.22±0.73)分、(1.97±0.58)分](均P<0.05),1月组、2月组与连续组比较差异无统计学意义(均P>0.05)。3月组3、6、9、12个月后VEGF mRNA[分别为(800.94±101.85)、(714.52±84.66)、(620.51±97.82)、(573.30±111.26)]和Ang-2[分别为(0.40±0.11)ng·mL^(-1)、(0.35±0.10)ng·mL^(-1)、(0.30±0.09)ng·mL^(-1)、(0.28±0.06)ng·mL^(-1)]高于1月组VEGF mRNA[分别为(614.86±98.57)、(528.49±108.64)、(470.35±112.61)、(414.28±90.78)]和Ang-2[分别为(0.33±0.11)ng·mL^(-1)、(0.28±0.09)ng·mL^(-1)、(0.21±0.07)ng·mL^(-1)、(0.17±0.05)ng·mL^(-1)],亦高于2月组VEGF mRNA[分别为(621.35±113.04)、(537.11±85.59)、(482.67±109.34)、(419.56±93.45)]和Ang-2[(0.34±0.12)ng·mL^(-1)、(0.2Objective To explore the efficacy,mechanism,and safety of cyclical treatment with tripterygium wilfordii(TW)for rheumatoid arthritis(RA)in women of childbearing age.Methods A total of 200 female RA patients of childbearing age treated in 980th Hospital of Joint Logistics Support Force from January 2021 to October 2023 were divided into four groups using a random number table method,with 50 in each group.TW was administered continuously in the continuous group.Meanwhile,TW was given at 1-month intervals in the 1-month group,at 2-month intervals in the 2-month group and at 3-month intervals in the 3-month group.The duration of treatment was 12 months in all the four groups.The efficacy,disease activity score indicated by 28 joint counts(DAS28)score,changes in angiogenic factors(vascular endothelial growth fac tor(VEGF)mRNA,angiopoietin-2(Ang-2)),reproductive toxicity and other adverse reactions were compared among the four groups.Results The ACR20,ACR50 and ACR70 in the 3-month group were 70.00%(35/50),34.00%(17/50)and 4.00%(2/50),respectively,which were lower than those in the 1-month group(84.00%(42/50),56.00%(28/50)and 24.00%(12/50))and the 2-month group(80.00%(40/50),52.00%(26/50)and 20.00%(10/50))(χ^(2)=10.027,8.724,13.000,P<0.05).There was no significant difference between the 1-month group and the continuous group as well as between the 2-month group and the continuous group(P>0.05).The DAS28 scores after 3,6,9,and 12 months in the 3-month group were(6.42±2.13)points,(5.04±1.59)points,(4.40±1.31)points and(3.84±1.220)points,respectively,which were higher than those in the 1-month group((5.28±1.75) points,(3.75±1.20)points,(2.17±0.70)points and(1.88±0.61)points)and the 2-month group((5.41±1.80)points,(3.81±1.18)points,(2.22±0.73)points and(1.97±0.58)points)(P<0.05).There was no significant difference between the 1-month group and the continuous group as well as between the 2-month group and the continuous group(P>0.05).After 3,6,9,and 12 months of treatment,the VEGF mRNA was(800.94±101.85),(714.

关 键 词：雷公藤 时间治疗 周期用药 育龄期 类风湿性关节炎 抑制血管生成 生殖毒性 

分 类 号：R593.22[医药卫生—内科学]