雷公藤多苷片联合甲氨蝶呤治疗类风湿性关节炎的效果

Effect of Tripterygium Glycosides Tablets combined with Methotrexate in treatment of rheumatoid arthritis

目的探讨雷公藤多苷片联合甲氨蝶呤治疗类风湿性关节炎(RA)的效果。方法选取于2013年2月～2017年9月在成都军区总医院就诊的RA患者48例,按照随机数字表法将患者分为观察组(24例)和对照组(24例)。对照组给予口服甲氨蝶呤治疗,观察组在对照组治疗的基础上给予口服雷公藤多苷片治疗,两组患者均治疗6个月。观察两组患者临床疗效及临床症状[视觉模拟评分(VAS)、压痛关节数、肿胀关节数、晨僵时间]变化,观察并比较两组患者关节炎性指标白介素-6(IL-6)、白介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)及生化相关指标红细胞沉降率(ESR)、C反应蛋白(CRP)以及类风湿因子(RF)抗抗环瓜氨酸多肽(CCP)抗体、抗角蛋白抗体(AKA)阳性率的变化,记录两组患者不良反应发生情况。结果治疗后,观察组临床疗效评估总效率优于对照组,差异有统计学意义(P<0.05);两组患者治疗前,VAS评分、压痛关节数、肿胀关节数、晨僵时间比较,差异无统计学意义(P>0.05);治疗后,两组患者VAS评分、压痛关节数、肿胀关节数、晨僵时间均较治疗前明显缓解减轻,且观察组均明显优于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者上述各关节炎性及生化相关指标均低于治疗前,且观察组均明显低于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者抗CCP抗体、AKA抗体阳性率均低于治疗前,且观察组抗CCP抗体、AKA抗体阳性率均明显低于对照组,差异有统计学意义(P<0.05)。两组患者的不良反应均属于轻微可控制,大部分不良反应可以通过对症药物治疗缓解。结论雷公藤多苷片联合甲氨蝶呤治疗RA临床效果良好,可有效抑制RF及外周血清IL-6、IL-1、TNF-α水平表达,减轻炎性反应,有效缓解改善RA患者临床症状,减轻患者疼痛,降低不良反应发生,值得临床推广。

Objective To investigate the effect of Tripterygium Glycosides Tablets combined with Methotrexate in treating rheumatoid arthritis. Methods Forty-eight patients with RA in General Hospital of Chengdu Military Region Hospital from February 2013 to September 2017 were divided into observation group(24 cases) and control group(24 cases)according to the random number table method. The control group was treated with oral Methotrexate, the observation group was treated with oral Tripterygium Polyglycoside Tablets on the basis of the treatment of the control group, both groups were treated for 6 months. The changes of clinical efficacy and symptom bodies visual analogue score(VAS),number of tender joints, number of swollen joints, and time of morning stiffness) were observed. The inflammatory indexes interleukin-6(IL-6) and interleukin-1(IL-1), serum tumor necrosis factor-α(TNF-α) and related biochemical index erythrocyte sedimentation rate(ESR), C-reactive protein(CRP) and rheumatoid factor(RF) anti CCP antibody, AKA positive change of patients were compared between two groups, adverse reactions occurred in both groups were recorded. Results After treatment, the total efficiency of clinical efficacy evaluation in the observation group was better than that in the control group, and the difference was statistically significant(P < 0.05). Before treatment, there were no significant difference in VAS score,number of tender joints, number of swollen joints, and time of morning stiffness between the two groups(P > 0.05). After treatment, VAS score, number of tender joints, number of swollen joints, and time of morning stiffness in both groups were significantly reduced compared with those before treatment, and the observation group was significantly better than the control group, with statistically significant differences(P < 0.05). After treatment, the above indicators of joint inflammation and biochemical correlation were lower in both groups than before treatment, and the observation group was significantly lower than the control group, with statistically significant differences(P < 0.05). After treatment,the positive rates of anti-CCP antibodies and AKA antibodies in the two groups were lower than those before treatment,and the positive rates of anti-CCP antibodies and AKA antibodies in the observation group were significantly lower than those in the control group, with statistically significant differences(P < 0.05). The adverse reactions in both groups were mild and controllable, and most of them could be alleviated by symptomatic drug therapy. Conclusion Tripterygium Polyglycoside Tablets combined with Methotrexate has a good clinical effect in the treatment of RA. It can effectively inhibit the expression of RF and the levels of IL-6, IL-1, TNF-α in peripheral blood serum, reduce the inflammatory reaction, effectively alleviate and improve the clinical symptoms of RA patients, reduce the pain and the occurrence of adverse reactions, which is worthy of clinical promotion.