雷公藤多苷片联合甲氨蝶呤治疗类风湿关节炎对患者骨代谢及血清炎性因子水平的影响

Effects of tripterygium wilfordii combined with methotrexate on bone metabolism and levels of inflammatory factors in serum in patients with rheumatoid arthritis

目的探究雷公藤多苷联合甲氨蝶呤对类风湿关节炎患者骨代谢与血清巨噬细胞集落刺激因子(M-CSF)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平的影响。方法选取2018年5月至2019年7月郑州人民医院收治的类风湿关节炎患者108例,按照随机数字表法分为常规组及联合组,每组54例。常规组单用甲氨蝶呤治疗,联合组行雷公藤多苷联合甲氨蝶呤治疗,比较两组患者治疗前后的症状、体征、骨代谢指标及血清细胞因子水平,同时比较两组患者的治疗效果。结果联合组有效率为81.48%(44/54),优于常规组的66.67%(36/54),P<0.05。两组患者治疗前症状、体征、骨代谢指标及血清细胞因子水平比较差异均未见统计学意义(P>0.05)。治疗后,联合组患者疼痛视觉模拟评分[(0.99±0.37)分],晨僵时间[(21.43±6.42)min],优于常规组[(1.28±0.46)分、(29.57±7.08)min],P<0.05;且其关节肿胀数、20 m步行时间均优于常规组及治疗前(P<0.05)。联合组治疗后血清V端中段骨钙素、β-胶原降解产物及Ⅰ型胶原氨基端延长肽水平分别为(21.34±5.14)、(0.56±0.12)、(37.05±7.61)ng/ml,M-CSF、IL-6及IL-8分别为(10.14±2.48)mg/L、(2.46±0.45)ng/ml及(56.21±12.73)ng/ml,均优于常规组及其治疗前(P<0.05)。结论雷公藤多苷联合甲氨蝶呤治疗类风湿关节炎,能够有效提高临床疗效,同时有助于改善患者骨代谢指标及血清M-CSF、IL-6、IL-8表达。

Objective To investigate the effects of tripterygium wilfordii combined with methotrexate on bone metabolism and levels of macrophage colony stimulating factor (M-CSF), interleukin-6 (IL-6) and interleukin-8 (IL-8) in serum in patients with rheumatoid arthritis.Methods A total of 108 patients treated in Zhengzhou People’s Hospital from May 2018 to July 2019 were divided into the conventional group and combined group by random number table method, with 54 cases in each group. Patients in the conventional group were only given methotrexate, while patients in the combined group were treated with tripterygium wilfordii combined with methotrexate. The symptoms, signs, bone metabolism indicators and serum cytokine levels of the two groups were compared before and after treatment. Moreover, the treatment effects of the two groups were compared.Results The effective rate of the combined group was 81.48% (44/54), which was significantly better than the 66.67% (36/54) of the conventional group (P<0.05). There were no significant differences in symptoms, signs, bone metabolic markers or serum cytokine levels between the two groups before treatment (P>0.05). After treatment, the visual analogue scale (VAS) score of the combined group was 0.99±0.37, and the morning stiffness time was (21.43±6.42)min, which were significantly better than the 1.28±0.46 and (29.57±7.08)min of the conventional group (P<0.05). After treatment, the joint swelling number, 20 meters walking time of the combined group were improved, and they were superior to the indexes of the conventional group (P<0.05). The levels of human osteocalcin N-terminal in the middle (N-MID), β-crosslaps (β-CTX) and total procollagen type 1 amino-terminal propeptide (T-P1NP) in the combined group were (21.34±5.14)ng/ml, (0.56±0.12)ng/ml, (37.05±7.61)ng/ml, respectively;M-CSF, IL-6 and IL-8 in the combined group were (10.14±2.48)mg/L, (2.46±0.45)ng/ml, (56.21±12.73)ng/ml, respectively, which were significantly improved and better than those of the conventional group (P<0.05).ConclusionsIn the treatment of rheumatoid arthritis, tripterygium wilfordii combined with methotrexate can effectively improve the clinical efficacy and help to improve the bone metabolism indexes and expression of M-CSF, IL-6 and IL-8.