托法替布联合甲氨蝶呤对类风湿关节炎患者血清炎性因子及骨代谢的影响

Effect of Tofacatib Combined with Methotrexate on Serum Inflammatory Factors and Bone Metabolism in Patients with Rheumatoid Arthritis

目的探究托法替布联合甲氨蝶呤在类风湿关节炎治疗中的应用价值.方法选取2021年5月—2022年6月本院收治的类风湿关节炎患者90例,采用随机数字表法分为对照组(n=45)及观察组(n=45).对照组采用甲氨蝶呤治疗,观察组在此基础上采用托法替布治疗,两组均持续治疗12周.比较两组患者的临床症状、血清炎性因子、骨代谢及不良反应发生情况.结果治疗后,观察组的关节肿胀数、关节压痛数、28个关节疾病活动度评分分别为(3.16±1.05)个、(2.68±1.14)个、(2.05±0.49)分,均低于对照组的(4.32±1.33)个、(4.73±1.46)个、(3.57±0.82)分,晨僵时间为(31.28±12.87)min,短于对照组的(42.29±13.54)min,组间差异有统计学意义(P<0.05).治疗后,观察组的白细胞介素-6、白细胞介素-1β、白细胞介素-17、肿瘤坏死因子-α水平分别为(19.59±3.82)ng/L、(9.80±1.92)ng/L、(7.29±1.84)ng/L、(5.19±0.48)pg/mL,均低于对照组的(25.78±4.63)ng/L、(12.49±2.37)ng/L、(9.85±2.55)ng/L、(6.74±0.59)pg/mL,组间差异有统计学意义(P<0.05).治疗后,观察组的总I型胶原氨基端延长肽、骨钙素N端中分子水平分别为(44.78±4.49)ng/mL、(19.16±1.93)ng/mL,均高于对照组的(35.49±3.56)ng/mL、(14.97±1.44)ng/mL,β-胶原降解产物水平为(0.55±0.07)pg/mL,低于对照组的(0.72±0.12)pg/mL,组间差异有统计学意义(P<0.05).两组的不良反应总发生率比较,差异无统计学意义(P>0.05).结论托法替布联合甲氨蝶呤能减轻类风湿关节炎患者的临床症状及炎症反应,促进骨代谢改善,且不良反应较少,值得临床推广使用.

Objective To explore the application value of tofacatib combined with methotrexate in the treatment of rheumatoid arthritis.Methods 90 patients with rheumatoid arthritis admitted to the hospital from May 2021 to June 2022 were selected and were divided into a control group(n=45)and an observation group(n=45)by random number table method.The control group was treated with methotrexate,and the observation group was treated with tofacatib on this basis.Both groups were treated for 12 weeks.The clinical symptoms,serum inflammatory factors,bone metabolism and the occurrence of adverse reactions were compared between the two groups.Results After treatment,the number of joint swelling,joint tenderness and disease activity score 28 in the observation group were(3.16±1.05),(2.68±1.14)and(2.05±0.49)points,respectively,which were lower than(4.32±1.33),(4.73±1.46)and(3.57±0.82)points in the control group,while the morning stiffness time was(31.28±12.87)min,which was shorter than(42.29±13.54)min in the control group,the differences between the groups were statistically significant(P<0.05).After treatment,the levels of interleukin-6,interleukin-1β,interleukin-17 and tumor necrosis factor-αin the observation group were(19.59±3.82)ng/L,(9.80±1.92)ng/L,(7.29±1.84)ng/L,(5.19±0.48)pg/mL,respectively,which were lower than(25.78±4.63)ng/L,(12.49±2.37)ng/L,(9.85±2.55)ng/L,(6.74±0.59)pg/mL in the control group,and the differences between the groups were statistically significant(P<0.05).After treatment,the molecular levels of total N-terminal propeptide of type I procollagen and N-MID Osteocalcin in the observation group were(44.78±4.49)ng/mL and(19.16±1.93)ng/mL,which were higher than(35.49±3.56)ng/mL and(14.97±1.44)ng/mL in the control group,while the level ofβ-C-terminal telopeptide of type I collagen was(0.55±0.07)pg/mL,lower than(0.72±0.12)pg/mL in the control group,and the differences between the groups were statistically significant(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Tofacatib combined with methotrexate can reduce the clinical symptoms and inflammatory response of patients with rheumatoid arthritis,promote the improvement of bone metabolism,and less adverse reactions,and is worthy of clinical promotion and use.