艾拉莫德片联合双醋瑞因治疗类风湿关节炎的临床疗效及对患者血清IL-17、IL-23水平的影响

Curative Efficacy of Iguratimod Tablets Combined Diacerein in the Treatment of Rheumatoid Arthritis and its Effect on the serum IL-17 and IL-23 Levels

目的:探讨艾拉莫德片联合双醋瑞因治疗类风湿关节炎的临床疗效及对患者血清白介素(IL)-17、IL-23水平的影响。方法:选择2015年9月至2017年9月我院接诊的96例类风湿关节炎患者,通过随机数表法将其分为观察组(n=48)和对照组(n=48),两组均给予甲氨蝶呤片及常规对症治疗,对照组在此基础上给予艾拉莫德片治疗,观察组在对照组的基础上联合双醋瑞因胶囊治疗,两组均以4周为1个疗程,连续治疗6个疗程。比较两组的临床疗效、治疗前后临床症状评分、实验室指标[红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)]、免疫学指标[免疫球蛋白(Ig)G、IgA、IgM]及血清IL-17、IL-23水平的变化及治疗期间不良反应的发生情况。结果:治疗后,观察组临床疗效总有效率为89.58%(43/48),明显高于对照组的70.83%(34/48)(P<0.05);两组关节疼痛、关节压痛、关节肿胀、晨僵时间评分、ESR、CRP、RF、IgG、IgA、IgM较治疗前均显著降低(P<0.05),观察组以上指标均明显低于对照组(P<0.05);两组血清IL-17、IL-23水平均较治疗前显著降低(P<0.05),观察组血清IL-17、IL-23水平均明显低于对照组[(11.23±1.30)pg/ml vs(16.49±1.79)pg/mL,(83.41±10.25)pg/mL vs(103.52±12.47)pg/mL](P<0.05)。两组治疗期间药物不良反应总发生率比较无显著差异(P>0.05)。结论;艾拉莫德片联合双醋瑞因治疗类风湿关节炎患者的效果显著,可明显改善患者的临床症状,促进关节功能恢复,其内在机制可能和降低血清IL-17、IL-23的表达相关。

Objective： To study the clincial efficacy of Iguratimod tablets combined diacerein in the treatment of rheumatoid arthritis and its effect on the serum interleukins（IL）-17 and IL-23 levels. Methods： 96 cases of patients with rheumatoid arthritis who admitted in our hospital from September 2015 to September 2017 were selected and divided into the observation group（n=48） and the control group（n=48） according to random number table, they were treated with Methotrexate Tablets and other routine symptomatic treatment, the control group was additionally treated by Iguratimod tablets, while the observation group was given Diacerein Capsules based on the control group. Both groups were treated for 6 courses（4 weeks as 1 course）. The clinical efficacy, changes of clinical symptom score, laboratory index [erythrocyte sedimentation rate（ESR）, C reactive protein（CRP）, rheumatoid factor（RF）], immunological index[immunoglobulin（Ig） G, IgA, IgM] and serum IL-17, IL-23 levels before and after treatment, and the incidence of adverse reactions during the treatment were compared between the two groups. Results： After treatment, the total effective rate of observation group was 89.58%（43/48）, which was significantly higher than that of the control group 70.83%（34/48）（P0.05）; the joint pain, joint pressure pain,joint swelling, morning stiffness time scores, ESR, CRP, RF, IgG, IgA, IgM of both groups were significantly lower than those be-fore treatment（P0.05）, and the indexes above in the observation group were significantly lower than those of the control group（P0.05）; the serum IL-17, IL-23 levels of both groups were significantly lower than those before treatment（P0.05）, which were signifi-cantly higher in the observation group than those of the control group [（11.23±1.30）pg/mL vs（16.49±1.79）pg/mL,（83.41±10.25）pg/mL vs（103.52±12.47）pg/mL]（P〈0.05）. There was no significant difference in the total incidence of adverse drug reactions during the treat-ment between the two groups（P0.05）. Conclusion： Iguratimod Tablets combined Diacerein can effectively improve the Clinical symp-toms and promote the recovery of joint function in the treatment of rheumatoid arthritis, it may be associated with the reduction of serum IL-17 and IL-23 levels.