依那西普联合环磷酰胺对类风湿性关节炎合并间质性肺炎患者相关指标的影响

Effects of Etanercept Combined with Cyclophosphamide on Related Indexes of Rheumatoid Arthritis Patients with Interstitial Pneumonia

目的:研究依那西普联合环磷酰胺对类风湿性关节炎合并间质性肺炎(RA-IP)患者相关指标的影响。方法:84例RA-IP患者按随机数字表法分为对照组(42例)和观察组(42例)。对照组患者给予注射用依那西普25 mg,皮下注射,每周2次;观察组患者在对照组治疗的基础上给予环磷酰胺片50 mg,口服,每日1次,7 d后增加50 mg,最大剂量不超过100 mg,连用2周后休息2周再重复。两组均治疗3个月。观察两组患者治疗前后关节压痛数、关节肿胀数、晨僵时间、视觉模拟评分法(VAS)评分、28个关节疾病活动度评分(DAS28)、C反应蛋白(CRP)、红细胞沉降率(ESR)、类风湿因子(RF)、肿瘤坏死因子(TNF-α)、动脉血氧分压[p(O_2)]、肺活量(VC)、临床评分、影像学评分、生理评分及不良反应发生情况。结果:治疗后,两组患者关节压痛数、关节肿胀数、晨僵时间、VAS评分、DAS28评分和CRP、ESR、RF、TNF-α水平以及临床评分、影像学评分、生理评分均显著低于同组治疗前,且观察组显著低于对照组;两组患者p(O_2)、VC均显著高于同组治疗前,且观察组显著高于对照组,差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:依那西普联合环磷酰胺可显著改善RA-IP患者的临床症状、体征、生活质量及肺功能,且未增加不良反应的发生。

OBJECTIVE： To study the effects of etanercept combined with cyclophosphamide on related indexes of patients with rheumatoid arthritis complicated with interstitial pneumonia （RA-IP）. METHODS： A total of 84 RA-IP patients were randomly divided into control group （42 cases） and observation group （42 cases）. Control group was given Etanercept for injection 25 mg subcutaneously twice a day. Observation group was additionally given Cyclophosphamide tablets 50 mg orally, once a day, increasing by 50 mg every 7 d later, with maximum dose lower than 100 mg, for consecutive 2 weeks, 2 weeks later repeated, on the basis of control group. Both groups were treated for 3 months. The number of joint tenderness and joint swelling, morning stiffness time, VAS score, DAS28 score, CRP, ESR, serum rheumatoid factor （RF）, TNF-a, p （O2）, VC, clinical score, imaging score, physiological score and the occurrence of ADR were observed in 2 groups before and after treatment. RESULTS： After treatment, the number of joint tenderness and joint swelling, morning stiffness time, VAS score, DAS28 score, the levels of CRP, ESR, RF and TNF-ct, clinical score, imaging score, physiological score in 2 groups were significantly lower than before treatment; the observation group was significantly lower than control group, p（O2） and VC of 2 groups were significantly higher than before treatment, and the observation group was significantly higher than the control group, with statistical significance （P〈 0.05）. There was no statistical significance in the incidence of ADR between 2 groups （P〉0.05）. CONCLUSIONS： Etanercept combined with cyclophophamide in the treatment of RA-IP can improve clinical symptom, signs, life quality and lung function without increasing the occurrence of ADR.