甲泼尼龙联合甲氨蝶呤治疗类风湿关节炎临床疗效及作用机制研究

Clinical efficacy and mechanism of chlorella desmoside combined with methylprednisolone in the treatment of rheumatoid arthritis

目的探究甲泼尼龙联合甲氨蝶呤在治疗类风湿关节炎(RA)中的效果,并对其作用机制进行探究。方法选取2014年1月—2017年1月于来西安市第五医院就诊120例RA患者,按照随机数字表法分为观察组和对照组,各60例。对照组患者单纯使用甲氨蝶呤10 mg/次,1次/周,12周为1疗程;观察组在对照组基础上加用甲泼尼龙片,前4周8 mg/次,1次/d,4周逐渐减量改为2 mg/次,1次/d,12周为1疗程。治疗1周后对两组28个关节疾病活动度评分(DAS-28)进行对比,治疗12周后对两组红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)进行对比,采用视觉模拟量表(VAS)对两组患者治疗前后疼痛度进行评价。结果治疗1周后,两组DAS-28评分均有下降,同组治疗前后比较差异有统计学意义(P<0.05);且观察组得分低于对照组,差异具有统计学意义(P<0.05)。治疗12周后,两组ESR、CRP明显降低,同组治疗前后比较差异有统计学意义(P<0.05);但观察组ESR较对照组更慢,CRP含量更少,差异具有统计学意义(P<0.05)。RF检测观察组阳性率为41.67%,低于对照组的58.33%,差异具有统计学意义(P<0.05);VAS治疗前两组差异无统计学差异,治疗后观察组得分明显低于对照组,差异具有统计学意义(P<0.05)。结论甲泼尼龙联合甲氨蝶呤在治疗RA效果显著,其机制为甲氨蝶呤能够抑制体内T细胞的增值,起到一定免疫抑制作用,甲泼尼龙能够延缓炎症反应对关节的破坏,也能够降低甲氨蝶呤在使用过程中的不良反应,二者联合应用效果显著,值得进行临床推广。

Objective To investigate the effect of methotrexate(MTX) combined with methylprednisolone in the treatment of rheumatoid arthritis(RA), and to explore its mechanism;Methods From January 2014 to January 2017, 120 patients with RA were randomly divided into experimental group and control group according to the random number table method. The control group was treated with MTX alone. The experimental group received MTX(DAS-28) were compared between the two groups after 12 weeks of treatment. After 12 weeks of treatment, the erythrocyte sedimentation rate(ESR), C-reactive protein(CRP) Rheumatoid factor(RF) were compared, the visual analogue scale(VAS) was used to evaluate the pain before and after treatment.Results After 1 week of treatment, the scores of DAS-28 decreased, and the score of the experimental group was lower than that of the control group(P <0.05). After 12 weeks of treatment, the ESR and CRP were significantly decreased(P < 0.05). The positive rate of RF test was41.67% in the experimental group and 58.33% lower than that in the control group. The difference between the two groups before and after VAS treatment was significantly higher than that of the control group(P < 0.05), but the difference was statistically significant(P < 0.05). The scores of the experimental group were significantly lower than those of the control group(P < 0.05).Conclusion TX combined with methylprednisolone in the treatment of RA effect is significant, the mechanism for the MTX can inhibit the value of T cells in the body, play a certain immunosuppressive effect, methylprednisolone can delay the inflammatory response to joint damage, can also reduce the MTX in The use of the process of adverse reactions, the combined effect of the two significant, worthy of clinical promotion.