雷公藤多苷联合注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白对类风湿性关节炎患者血清血管内皮生长因子、类风湿因子和人核因子κB受体活因子配体的影响

Effect of Tripterygium glycosides combined with Recombinant human tumor necrosis factor receptor Ⅱ antibody fusion protein for injection on serum vascular endothelial growth factor, rheumatoid factor, receptor activator of nuclear factor κ B ligand levels in patients with rheumatoid arthritis

目的探讨雷公藤多苷联合注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白对类风湿性关节炎患者血清血管内皮生长因子、类风湿因子、人核因子κB受体活因子配体水平的影响,为临床合理应用提供参考依据。方法将2014年12月至2016年1月安徽省淮北市人民医院收治的132例类风湿性关节炎患者采用随机数字表法随机分为观察组和对照组,每组66例。对照组单独应用雷公藤多苷片(每次10 mg,3次/d,口服)进行治疗,疗程3个月。观察组应用雷公藤多苷片(每次10 mg,3次/d,口服)联合注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白(按照0.4 mg/kg皮下注射,1次/周)进行治疗,疗程3个月。对比两组患者治疗后的临床疗效,以及血清血管内皮生长因子、类风湿因子、人核因子κB受体活因子配体水平的变化。结果观察组治疗有效率为92.4%(61/66),明显高于对照组的80.3%(53/66),两组比较差异有统计学意义(χ^2=4.117,P<0.05)。观察组与对照组患者治疗前血清血管内皮生长因子、类风湿因子、人核因子κB受体活因子配体水平比较差异均无统计学意义(t值分别为0.174、0.103、0.359,P均>0.05);治疗后观察组与对照组血清血管内皮生长因子、类风湿因子、人核因子κB受体活因子配体水平分别为(20.8±11.5) ng/L与(27.3±13.1) ng/L,(258.4±54.5) U/L与(298.1±49.5) U/L,(0.083±0.021)pmol/L与(0.197±0.064)pmol/L,两组比较差异均有统计学意义(t值分别为3.029、4.381、13.750,P均<0.05)。对照组不良反应发生率为10.5%(7/66),明显高于观察组的1.5%(1/66),两组比较差异有统计学意义(χ^2=4.790,P<0.05)。对照组1年复发率为25.0%(13/52),观察组为6.7%(4/60),两组比较差异有统计学意义(χ^2=7.272,P<0.05)。结论雷公藤多苷联合注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白治疗类风湿关节炎效果较好,降低了患者血清血管内皮生长因子、类风湿因子、人核因子κB受体活因子配体的水平,其不良反应发生率及复发率低。

Objective To investigate the effect of tripterygium glycosides combined with recombinant human tumor necrosis factor receptor Ⅱ antibody fusion protein for injection on serum vascular endothelial growth factor(VEGF), rheumatoid factor(RF), receptor activator of nuclear factor κ B ligand(RANKL) levels in patients with rheumatoid arthritis.To provide reference for rational clinical application. Methods From December 2014 to January 2016, 132 patients with rheumatoid arthritis were divided into observation group and control group by random number table method,, with 66 cases in each group, The control group was treated with tripterygium glycosides alone (10 mg each time, 3 times daily, orally) for 3 months.The observation group was treated with a combination of tripterygium glycosides and recombinant human tumor necrosis factor receptor Ⅱ(0.4 mg/kg, once weekly, hypodermic injection)for 3 months.The clinical efficacy, and serum VEGF, RF and RANKL levels were compared between 2 groups. Results The effective rate of the observation group was 92.4%(61/66), which was significantly higher than that in the control group (80.3%, 53/66). There was a significant difference between the two groups (χ^2=4.117, P<0.05). There was no significant difference in the levels of serum VEGF, RF and RANKL between the two groups (t=0.174, 0.103, 0.359, all P>0.05). After treatment, the levels of serum VEGF, RF and RANKL in the observation group and the control group were (20.8±11.5) ng/L and (27.3±13.1)ng/L,(258.4±54.5)U/L and (298.1±49.5)U/L,(0.083±0.021) pmol/L and (0.197±0.064), respectively.There were significant differences between the two groups (t=3.029, 4.381, 13.750, all P<0.05). The incidence rate of adverse reactions in the control group was 10.5%(7/66), which was significantly higher than that in the observation group (1.5%, 1/66). There was a significant difference between the two groups(χ^2=4.790, P<0.05). The one-year recurrence rate was 25.0%(13/52) in the control group and that was 6.7%(4/60) in the observation group, respectively, and there was a significant difference between the two groups(χ^2=7.272, P<0.05). Conclusion Tripterygium glycosidescombined with recombinant human tumor necrosis factor receptor Ⅱ antibody fusion protein for injection is effective in the treatment of rheumatoid arthritis, which reduces the levels of serum VEGF, RF and RANKL, and has a low incidence of adverse reactions and recurrence.