双重血浆置换联合甲氨蝶呤对类风湿性关节炎患者血清巨噬细胞集落刺激因子、血管内皮生长因子水平的影响

Effect of Double Filtration Plasmapheresis Combined with Methotrexate on Serum Macrophage Colony Stimulating Factor and Vascular Endothelial Growth Factor in Patients with Rheumatoid Arthritis

目的:探讨双重血浆置换联合甲氨蝶呤对类风湿性关节炎患者血清巨噬细胞集落刺激因子(M-CSF)及血管内皮生长因子(VEGF)的影响。方法:选取2017年1月至2018年12月沧州中西医结合医院收治的类风湿关节炎患者80例,随机分为研究组与对照组,每组40例。对照组患者给予甲氨蝶呤治疗,研究组患者在对照组的基础上给予双重滤过血浆置换治疗1次。观察两组患者治疗前后血清M-CSF、VEGF、炎症因子[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和白细胞介素17(IL-17)]水平及症状评分情况,比较两组患者临床疗效及治疗期间不良反应发生情况的差异。结果:治疗后,两组患者M-CSF、VEGF、TNF-α、IL-6及IL-17水平均较治疗前明显降低,且研究组患者明显优于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者压痛积分、晨僵时间、疼痛积分及肿胀积分均较治疗前明显改善,且研究组患者明显优于对照组,差异均有统计学意义(P<0.05)。研究组患者的总有效率为82.50%(33/40),明显高于对照组的55.00%(22/40),差异有统计学意义(P<0.05)。研究组、对照组患者的不良反应发生率分别为15.00%(6/40)、10.00%(4/40),差异无统计学意义(P>0.05)。结论:双重血浆置换联合甲氨蝶呤可降低类风湿关节炎患者体内的M-CSF、VEGF及炎症因子水平,减轻关节疼痛、肿胀和晨僵现象,疗效较好,安全性高。

OBJECTIVE:To probe into the effects of double filtration plasmapheresis combined with methotrexate on serum macrophage colony stimulating factor(M-CSF)and vascular endothelial growth factor(VEGF)in patients with rheumatoid arthritis.METHODS:80 patients with rheumatoid arthritis admitted into Cangzhou Hospital of Integrated TCM-WM from Jan.2017 to Dec.2018 were selected and randomly divided into research group and control group,with 40 cases in each group.The control group was treated with methotrexate,while the research group was given double filtration plasmapheresis once based on the control group.The serum M-CSF,VEGF,inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-17(IL-17)]levels and symptom scores of the two groups were observed before and after treatment.Differences in clinical efficacy and incidences of adverse drug reactions during treatment were compared between two groups.RESULTS:After treatment,the M-CSF,VEGF,TNF-α,IL-6 and IL-17 levels of both groups were significantly improved,and those of the research group were significantly better than the control group,with statistically significant differences(P<0.05).After treatment,the tenderness scores,morning stiffness,pain scores and swelling scores of two groups were significantly improved,and those of the research group were significantly better than the control group,with statistically significant differences(P<0.05).The effective rate of research group was 82.50%(33/40),which was significantly higher than that of the control group(55.00%,22/40),with statistically significant difference(P<0.05).The incidences of adverse drug reactions of research group and control group were respectively 15.00%(6/40)and 10.00%(4/40),the difference had no statistical significance(P>0.05).CONCLUSIONS:The combination of double filtration plasmapheresis and methotrexate can reduce the M-CSF,VEGF and inflammatory factor levels in patients with rheumatoid arthritis,which can relieve arthralgia,arthrocele and morning stiffness,with remarkable efficacy and good safety.