药物联合血浆置换治疗难治性类风湿关节炎的临床观察

Clinical observation of drugs combined with plasma exchange in the treatment of refractory rheumatoid arthritis

目的探讨药物联合血浆置换(PE)在难治性类风湿关节炎(RA)治疗中的价值。方法将80例难治性RA患者随机分成PE治疗组和对照组各40例,比较两组患者治疗前及治疗后7d、28d、56d的28个关节活动疾病指数(DAS28)、疼痛视觉模拟评分(VAS)、类风湿因子(RF)、红细胞沉降率(ESR)、C反应蛋白(CRP)、抗环瓜氨酸肽(CCP)抗体、淋巴细胞水平及疗效。结果PE治疗组较对照组治疗后第7d、28d、56d的DAS28、VAS、ESR水平及第7d、28d的RF、抗CCP抗体、CRP水平均明显降低(P<0.05),美国风湿病学会(ACR)20、ACR50、ACR70明显改善(P<0.05)。治疗后第7d、28dPE治疗组CD3+T淋巴细胞比例较治疗前明显升高(P<0.05),CD8+T细胞比例较治疗前明显降低(P<0.05);CD4+T细胞比例较治疗前和同时间对照组均明显升高(P<0.05)。PE治疗组第7d、28d的CD4+/CD8+T淋巴细胞比值较治疗前和与同期对照组均明显升高(P<0.05),而对照组治疗前后比较差异无统计学意义(P>0.05)。PE治疗不良反应轻,对症处理后病情均好转。结论药物联合PE治疗能迅速缓解难治性RA患者的临床症状,不良反应轻,对难治性RA有明显治疗效果。

Objective To evaluate the value of drug combined with plasma exchange(PE)in the treatment of refractory rheumatoid arthritis(RA).Methods A total of 80 cases of refractory RA patients were randomly divided into PE treatment group and control group with 40 cases in each group.Disease activity score 28(DAS28),VAS,rheumatoid factor(RF),erythrocyte sedimentation rate(ESR),C?reactive protein(CRP),anti-cyclic citrullinated peptide(CCP)antibodies,lymphocytes and efficacy were compared before treatment and at 7 d,28 d,and 56 d after treatment.Results Compared with the control group,DAS28,VAS,ESR in the PE treatment group were significantly decreased at 7 d,28 d and 56 d after treatment,and RF,anti-CCP antibody,CRP were significantly decreased at 7 d,28 d after treatment(P<0.05).American college of rheumatology(ACR)20,ACR50 and ACR70 were significantly improved(P<0.05).The ratios of CD3+T cells in the PE group was significantly higher at 7 d and 28 d than those before treatment(P<0.05),the ratios of CD8+T lymphocytes were significantly lower than those before treatment(P<0.05),and the ratio of CD4+T cells was significantly higher than those before treatment and at the same period in the control group(P<0.05).The ratio of CD4+/CD8+T lymphocytes in the PE treatment group was significantly higher than those before and at 7 d,28 d after the treatment(P<0.05),while the difference in the control group before and after treatment was not statistically significant(P>0.05).The adverse reaction of PE treatment was mild,and the condition was improved after symptomatic treatment.Conclusion Drug combined with PE therapy can quickly relieve the clinical symptoms of refractory RA patients with mild adverse reaction,and has an obvious therapeutic effect on refractory RA.