来氟米特对类风湿性关节炎患者TNF-α、IL-6、IL-17的影响机制

Mechanism of the effect of leflunomide on TNF-α,IL-6 and IL-17 in patients with rheumatoid arthritis

目的探讨来氟米特对类风湿性关节炎患者TNF-α、IL-6、IL-17的影响机制。方法收集我院收治的类风湿性关节炎患者168例,随机分为对照组和试验组,每组84例。对照组给予甲氨蝶呤7.5 mg,1次/d,口服;试验组在对照组基础上,给予来氟米特片20 mg,1次/d,口服。两组患者均治疗4个月。检测两组患者细胞因子TNF-α、IL-6、IL-17指标,比较两组患者临床疗效、不良反应发生率及临床症状改善情况。结果治疗后,试验组患者总有效率(82.14%)高于对照组(70.24%),差异有统计学意义(P<0.05);两组患者的细胞因子TNF-α、IL-6、IL-17均降低,且两组比较差异有统计学意义(P<0.05);两组患者关节肿胀数减少,关节痛数减少,晨僵时间缩短,临床症状缓解改善,且两组比较差异有统计学意义(P<0.05);试验组出现口腔溃疡、皮肤瘙痒、恶心呕吐、腹胀腹泻等不良反应,两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论来氟米特片可明显改善类风湿性关节炎患者的症状,降低细胞因子TNF-α、IL-6、IL-17等指标,调节机体免疫机制,具有良好的临床疗效。

Objective To study the mechanism of the effect of leflunomide on TNF-α,IL-6 and IL-17 in the patients with rheumatoid arthritis. Methods Totally 168 patients with rheumatoid arthritis treated in our hospital were collected and randomly divided into control group（n = 84） and experiment group（n = 84）. Control group was given7. 5 mg of methotrexate orally,once daily; experiment group was given 7. 5 mg of methotrexate and 20 mg of leflunomide tablet orally,once daily. All the patients were treated for 4 months. The levels of TNF-α,IL-6 and IL-17 were detected,and the clinical efficacy,the incidence rate of adverse reaction and the improvement of symptoms of the two groups were compared. Results After treatment,the total effective rate in experiment group was higher than that of control group（82. 14 vs. 70. 24%,P 〈0. 05）; the levels of TNF-α,IL-6 and IL-17 of the patients were decreased,and there were significant differences between the two groups（P 〈0. 05）; the number of patients with joint swelling and joint pain was decreased,the time of morning stiffness was shortened,and the clinical symptoms were improved,there being significant difference between the two groups（P 〈0. 05）; patients in experiment group had adverse reactions of oral ulcers,itchy skin,nausea and vomiting,abdominal distention and diarrhea,and no significant difference in the incidence rate of adverse reactions was found between the two groups（P 〉0. 05）. Conclusion Leflunomide tablet can improve the clinical symptoms of patients with rheumatoid arthritis,decrease the levels of TNF-α,IL-6 and IL-17,and regulate the body＇s immune mechanism with good clinical efficacy.