通痹胶囊联合JAK抑制剂托法替布对RA患者VAS评分、MMP-3及ESR的影响

Effect of tongbi capsules combined with JAK inhibitor tofacitinib on VAS score, MMP-3 and ESR levels in RA patients

探讨通痹胶囊联合JAK抑制剂托法替布对RA患者视觉模拟疼痛量表(visual analogue pain scale,VAS)评分、基质金属蛋白酶(matrix metalloproteinase 3,MMP-3)、TNF-α及ESR等指标的影响。选取宝鸡市中心医院2017年2月至2018年2月收治的RA患者94例,按随机数字表法均分为观察组和对照组。对照组给予托法替布和甲氨蝶呤治疗,观察组在此基础上加用通痹胶囊。观察两组患者VAS评分,实验室指标ESR、RF、CRP、MMP-3、金属蛋白酶组织抑制物(tissue inhibitor of metalloproteinase 1,TIMP-1)、IL-1、TNF-α水平及不良反应发生情况并进行比较分析。结果显示,治疗后两组患者VAS评分均低于治疗前,且在3个月内呈逐渐下降趋势,3个月后观察组VAS评分为2.36±0.87,明显低于对照组2.92±0.94(P<0.05)。治疗后观察组患者ESR、RF、CRP水平分别为(16.94±9.37)mm/h、(130.84±15.43)U/mL、(9.15±5.25)mg/L,明显低于治疗前且明显低于对照组[分别为(21.53±7.27)mm/h、(141.92±11.73)U/mL和(13.35±7.41)mg/L](P<0.05)。治疗后两组患者的MMP-3、IL-1、TNF-α水平均低于治疗前,与对照组[分别为(60.51±7.27)ng/L、(0.23±0.11)μg/L和(107.38±21.35)μg/L]相比,观察组[分别为(54.94±4.37)ng/L、(0.16±0.10)μg/L和(91.35±20.64)μg/L]降低更明显(P<0.05),治疗后两组患者的TIMP-1水平均高于治疗前,与对照组(165.92±11.73)ng/L相比,观察组为(176.84±15.43)ng/L,两组差异具有统计学意义(P<0.05)。治疗后两组患者不良反应发生情况比较,观察组总发生率为31.91%,对照组为38.30%,但差异无统计学意义(P>0.05)。由此,通痹胶囊联合托法替布治疗RA能有效降低MMP-3、TNF-α等炎性因子水平,升高TIMP-1,减轻机体炎症反应并缓解疼痛;还可改善ESR、RF等实验室指标,控制病情发展,有较好的临床应用价值。

To investigate the effect of Tongbi capsules combined with JAK inhibitor tofacitinib on VAS score,matrix metalloproteinase(MMP-3),TNF-αand ESR in RA patients,94 RA patients admitted to Baoji Central Hospital from February 2017 to February 2018 were divided into observation group(47 cases)and control group(47 cases)according to random number table method.The patients in the control group were treated with tofacitinib and methotrexate,while the patients in the observation group were treated with additional Tongbi capsule besides the above treatment.The VAS score,laboratory parameters such as ESR,RF,CRP,MMP-3,tissue inhibitor of metalloproteinase 1(TIMP-1),IL-1,TNF-αand adverse reactions were observed and compared between the two groups.The results showed that the VAS scores in two groups after treatment were lower than those before treatment,and gradually decreased within three months.After three months,the VAS scores in observation group were 2.36±0.87,which was significantly lower than the control group(2.92±0.94,P<0.05).After treatment,the serum levels of ESR,RF and CRP in the observation group were 16.94±9.37 mm/h,130.84±15.43 U/mL,9.15±5.25 mg/L,respectively,which were significantly lower than those before treatment and in the control group(21.53±7.27 mm/h,141.92±11.73 U/mL,13.35±7.41 mg/L,respectively,P<0.05).After treatment,the levels of MMP-3,IL-1 and TNF-αin the two groups were lower than those before treatment.Compared with the control group(60.51±7.27 ng/L,0.23±0.11μg/L,107.38±21.35μg/L,respectively),the observation group(54.94±4.37 ng/L,0.16±0.10μg/L,91.35±20.64μg/L)decreased more significantly(P<0.05).The level of TIMP-1 in the two groups after treatment were higher than those before treatment.Compared with the control group(165.92±11.73 ng/L),the level of TIMP-1 in the observation group(176.84±15.43 ng/L)increased more significantly(P<0.05).After treatment,the total incidence of adverse reactions was 31.91%in the observation group,38.30%in the control group,but not significantly(P>0.05).Therefore,Tongbi capsule combined with tofacitinib in the treatment of RA can effectively reduce the levels of inflammatory factors such as MMP-3 and TNF-α,increase TIMP-1,alleviate inflammation and pain,improve the laboratory indexes such as ESR and RF.In conclusion,this combination of treatment may control the development of RA and have better clinical application value.