联合用药对类风湿关节炎促炎症细胞因子与急性相反应物的影响及疗效分析

The role of the combination therapy on the levels of pro-inflammatory cytokines and acute phase reactants in rheumatoid arthritis

目的探讨类风湿关节炎(rheumatoid arthritis,RA)患者应用甲氨蝶呤(methotrexate,MTX)+白芍总苷(total glu-cosides of paeonia,TGP)+来氟米特(leflunomide,LEF)治疗对促炎症细胞因子白介素-1β(IL-1β)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的影响,观察急性相反应物血沉(Erythrocyte Sedimentation Rate,ESR)和C反应蛋白(C-reactive protein,CRP)变化,并观察患者临床疗效。方法 40例RA患者,分别于治疗前、治疗12周后检测血清IL-1β、IL-6、TNF-α、ESR、CRP水平,记录健康评估问卷评分(Health Assessment Questionnaire records,HAQ),并根据触痛关节数、肿胀关节数和ESR计算出疾病活动指数(Disease activity score,DAS28),评估各项指标变化情况及临床疗效。结果治疗12周后,血清促炎因子IL-1β、IL-6、TNF-α水平显著降低,血清急性相反应物ESR、CRP水平下降,临床疗效评估HAQ评分、DAS28较前明显改善。ESR和CRP与IL-1β、IL-6及TNF-α均呈正相关(均P<0.05)。结论甲氨蝶呤与白芍总苷联合来氟米特可下调RA患者促炎症细胞因子IL-1β、IL-6及TNF-α水平,降低炎症指标,改善患者临床症状及生活质量,ESR、CRP与血清IL-1β、IL-6及TNF-α具有相关性。

Ohjeetlve To investigate role of therapy（ ＋LEF＋TGP）＇on the serum levels of pro-inflam- / matory cylokines IL-113, IL-6, TNF-a, erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） in rheumatoid arthritis （RA） patients. Methods In 40 RA patients,the Health Assessment Questionnaire （HAQ） score,DAS28,IL-113,IL-6,TNF-a,ESR, CRP at baseline and 12 weeks after treatment were determined respectively, and correlations between levels of pro-inflammatory cyto- kines and DAS28 were analyzed. Results After 12-week treatment, the serum IL-113, IL-6,TNF-cdevels were significantly lower, and a positive correlation between pro-inflammatory cytokines levels and DAS28 was found. Conclusions The combination threrapy by MTX, LEF, and TGP is effective in reducing pro-inflammatory cytokines in RA patients.