益赛普联合复方倍他米松注射液关节腔内注射治疗类风湿关节炎顽固性关节腔积液的临床观察

Clinical Observation on the Treatment of Intractable Articular Cavity Effusion of Rheumatoid Arthritis with Intraarticular Injection of Etanercept Combined with Compound Betamethasone Injection

目的:评价关节腔内注射复方倍他米松注射液联合重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(益赛普)治疗类风湿关节炎顽固性关节腔积液的疗效和安全性。方法:选取类风湿关节炎顽固性关节腔积液患者60例,按照随机数字表法分为A组(复方倍他米松注射液组)、B组(益赛普组)、C组(复方倍他米松注射液+益赛普组),每组20例,分别于膝关节腔内注射复方倍他米松注射液、益赛普、复方倍他米松注射液联合益赛普。于治疗后1周末、2周末、1个月末观察患者红细胞沉降率(ESR)、C-反应蛋白(CRP)、关节疼痛指数、滑膜血流信号变化等参数评价疗效,同时记录治疗过程中有无不良反应。结果:治疗后,3组ESR、CRP、关节疼痛指数、滑膜血流信号与治疗前比较均明显改善(P<0.05)。A组ESR、CRP在注射后1个月末时比较,差异无统计学意义(P>0.05),而B组、C组均持续改善,3组患者在疼痛指数评分、滑膜血流信号方面较治疗前均改善(P<0.05)。组间比较,3组ESR、CRP、疼痛指数评分、滑膜血流信号等指标在治疗1个月末时B组优于A组,而C组从治疗开始改善持续优于A组、B组。治疗过程中均未见严重不良反应。结论:益赛普联合复方倍他米松注射液关节腔注射治疗类风湿关节炎顽固性关节腔积液是一种能够有效控制住炎症反应的方法,安全性高,不良反应少,且不易复发,值得在临床中推广。

Objective：To evaluate the efficacy and safety of intra-articular injection of Compound Betamethasone Injection and etanercept in the treatment of intractable articular cavity effusion of rheumatoid arthritis.Methods：Sixty patients with refractory joint cavity effusion of rheumatoid arthritis were selected and randomly divided into group A（treated with Compound Betamethasone Injection）,group B（treated with etanercept）and group C（treated with Compound Beta methasone Injection and etanercept）.Each group had 20 cases.Respectively at the end of a week,two weeks and a month,the erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,joint pain index and synovial blood flow signal of the patients were evaluated.The adverse reactions were also recorded during the treatment.Results：After treatment,the ESR,CRP,joint pain index and synovial blood flow signals of the three groups were significantly improved compared with those before treatment（P 〈 0.05）.The difference of ESR and CRP in group A was not statistically significant（P 〉 0.05）at the end of a months after injection,while groups B and C were continuously improved.The three groups were improved in pain index score and synovial blood flow signal（P 〈 0.05）compared with those before treatment.In group comparison in ESR,CRP,pain index score and synovial blood flow signal at the end of a month,group A was better than group B,and group C was better than group A and group B from the beginning of treatment.No serious adverse reactions were found during the treatment.Conclusion：The treatment of intractable articular cavity effusion of rheumatoid arthritis with Compound Betamethasone Injection and etanercept is an effective method to control the inflammatory reaction.It has high safety,less adverse reactions and is not easy to relapse.It is worth popularizing in clinical practice.