青藤碱联合甲氨蝶呤治疗早期类风湿关节炎的疗效及对患者MMP-3、RANKL/OPG表达的影响

Efficacy of sinomenine combined with methotrexate on early rheumatoid arthritis and its influence on expressions of MMP-3 and RANKL/OPG

目的:观察青藤碱(SIN)联合甲氨蝶呤(MTX)治疗早期类风湿关节炎(RA)的疗效及对患者血清基质金属蛋白酶3(MMP-3)、核因子-κB受体活化因子配体(RANKL)/骨保护素(OPG)表达的影响。方法:纳入68例早期RA患者,按照随机数字表分为治疗组和对照组,每组各34例。对照组患者给予MTX治疗,治疗组患者给予MTX联合SIN治疗,两组疗程均为12周。采用美国风湿病学会(American College of Rheumatology,ACR)20、50、70标准评价两组患者的临床疗效,检测患者的类风湿因子(RF)、血沉(ESR)、C反应蛋白(CRP)及血清MMP-3、OPG、RANKL表达水平。结果:治疗后,治疗组的ACR 20、50、70达标率分别为76.7%、40.0%、3.3%,对照组分别为34.5%、20.7%、6.9%,治疗组的ACR 20达标率显著高于对照组(P<0.01)。治疗后,治疗组患者的RF、ESR、CRP水平均降低(P<0.01),对照组患者的RF、ESR、CRP水平与治疗前比较差异无统计学意义(P>0.05);且两组患者的ESR、CRP、RF水平治疗前后差值比较,差异均有统计学意义(P<0.01),治疗组患者上述指标的改善优于对照组。治疗后,治疗组患者的MMP-3、RANKL水平降低(P<0.01,P<0.05),OPG水平和OPG/RANKL比值升高(P<0.01,P<0.05);对照组患者的MMP-3水平亦降低(P<0.05);且两组患者的OPG、RANKL水平及OPG/RANKL比值治疗前后差值比较,差异均有统计学意义(P<0.01,P<0.05),治疗组患者上述指标的改善优于对照组。结论:SIN联合MTX可改善早期RA患者的临床症状,调控MMP-3及RANKL/OPG系统,这可能是其抑制骨侵蚀、促进骨保护的机制之一。

Objective: To observe the efficacy of sinomenine( SIN) combined with methotrexate( MTX) in the treatment of early rheumatoid arthritis( RA) and its influences on the serum expressions of matrix metalloproteinase-3( MMP-3) and receptor activator of nuclear factor κB ligand( RANKL)/osteoprotegerin( OPG). Methods: Sixty-eight patients with early RA were selected and divided into the treatment group and the control group according to the random number table,34 cases in each group. The patients in the control group were treated with MTX,and the patients in the treatment group were treated with SIN combined with MTX,with a course of 12 weeks. The clinical efficacy was evaluated by American College of Rheumatology( ACR) 20,50,70 criterion,and the levels of rheumatoid factor( RF),erythrocyte sedimentation rate( ESR) and C-reactive protein( CRP) and the serum expressions of MMP-3,OPG and RANKL were detected. Results: After treatment,the standard-reaching rates of ACR 20,50,70 in the treatment group were 76.7%,40.0% and3.3% respectively,and the standard-reaching rates in the control group were 34.5%,20.7% and 6.9% respectively. The standard-reaching rate of ACR 20 in the treatment group was higher than that in the control group( P<0.01). After treatment,the levels of RF,ESR and CRP in the treatment group were decreased( P<0.01),and there were no statistical differences on the levels of RF,ESR and CRP in the control group between treatment before and after( P>0.05);there were statistical differences between the two groups on the D-value of the levels of ESR,CRP and RF between before and after treatment( P<0.01),and the improvement on above indexes in the treatment group was better than that in the control group. After treatment,the levels of MMP-3 and RANKL in the treatment group were decreased( P<0.01,P<0.05),and the level of OPG and the radio of OPG/RANKL were increased( P<0.01,P<0.05);the level of MMP-3 in the control group was also decreased( P<0.05);there were statistical differences between the two groups on the D-value of the levels of OPG and RANKL and the radio of OPG/RANKL between before and after treatment( P<0.01,P<0.05),and the improvement on above indexes in the treatment group was better than that in the control group. Conclusion: SIN combined with MTX can improve the clinical symptoms of patients with early RA,and regulate the level of MMP-3 and the RANKL/OPG systems,which may be one of the mechanisms on its inhibiting bone erosion and promoting bone protection.