双重滤过血浆置换治疗类风湿关节炎35例效果观察

Effect Observation of Double Filtration Plasmapheresis in Treatment of 35 Patients with Rheumatoid Arthritis

目的探讨双重滤过血浆置换(DFPP)治疗类风湿关节炎(RA)的短期疗效及对血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)表达的影响。方法选择沧州市中西医结合医院于2015年6月—2016年7月收治的RA70例,按治疗方法分为治疗组和对照组,每组35例。对照组给予来氟米特联合甲氨蝶呤治疗,治疗组在对照组基础上给予DFPP治疗。观察治疗前后炎症指标、关节症状的变化情况,检测血清中IL-6、TNF-α的表达水平。结果治疗组治疗后1 d类风湿因子、血红细胞沉降率和C反应蛋白水平低于治疗前和对照组,治疗后7 d肿胀和压痛关节数目较治疗前减少,治疗后1、3、7 d IL-6、TNF-α水平较治疗前和对照组下降,且治疗后7 d较治疗后1 d下降明显(P<0.05)。结论 DFPP联合免疫抑制剂治疗RA可降低患者IL-6、TNF-α的表达水平,效果较好。

Objective To investigate short-term effect of double filtration plasmapheresis （DFPP） in treatment of patients with rheumatoid arthritis （RA） and influences on serum interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α） expressions. Methods A total of 70 patients with RA admitted during June 2015 and July 2016 were divided into treatment group and control group （n = 35 for each group） according to different treatment methods. Control group was treated with Leflunomide and Methotrexate, while treatment group was added DFPP on the basis of treatment for control group. In two groups, before and after treatment, inflammation indexes and changes of articular symptoms were observed, and serum IL-6 and TNF-α expressions were detected. Results In treatment group, levels of rheumatoid factor （RF）, erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） ld after treatment were significantly lower than those before treatment and in control group ; joint number of swelling and tenderness 7d after treatment were significantly decreased than those before treatment; IL-6 and TNF-α levels at 1st, 3rd and 7th days after treatment were significantly decreased compared with those before treatment and in control group, moreover, the decreased levels at 7th d after treatment were more obvious than those 1st d after treatment （P 〈0. 05）. Conclusion DFPP combined with immunosuppressive therapy in treatment of patients with RA can significantly decrease TNF-α and IL-6 expressions with good effect.