来氟米特联合甲氨蝶呤治疗幼年特发性关节炎的疗效

Curative effect of leflunomide combined with methotrexate in treatment of juvenile idiopathic arthritis

目的探讨来氟米特联合甲氨蝶呤对幼年特发性关节炎患儿免疫功能及血清基质金属蛋白酶-3(MMP-3)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平的影响。方法选取2018年10月至2019年10月首都儿科研究所附属儿童医院收治的70例幼年特发性关节炎患儿。纳入6~16周岁患儿,没有甲氨蝶呤和氟米特过敏史,排除免疫系统缺陷疾病、合并全身感染性疾病、肝肾功能或凝血功能不全及临床资料不完整等。按随机数字表法将其分为对照组、研究组,各35例。对照组给予甲氨蝶呤片进行治疗,研究组在对照组的基础上给予来氟米特片进行治疗,两组均治疗6个月。比较两组治疗前、治疗6个月后的临床症状及体征改善情况、免疫功能指标、血清细胞因子水平;统计两组治疗期间的不良反应发生率。计数资料采用卡方检验分析;计量资料采用t检验分析。结果与治疗前比较,治疗6个月后,两组幼年关节炎疾病活动性评分表(JADAS27)总分及血清免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、MMP-3、IL-1β、TNF-α水平均降低,且治疗6个月后,研究组均低于对照组(t=21.789、14.927、7.133、3.611、4.209、3.480、4.760,均为P<0.05)。治疗期间,研究组不良反应发生率(11.43%)与对照组(28.57%)相比,差异不具有统计学意义(P>0.05)。结论来氟米特联合甲氨蝶呤治疗幼年特发性关节炎,可明显降低患儿血清MMP-3、IL-1β、TNF-α水平,减轻机体炎症反应,同时可改善患儿免疫功能,改善临床症状及体征,且安全性良好。

Objective To investigate the effects of leflunomide combined with methotrexate on immune function and serum levels of matrix metalloproteinase-3(MMP-3),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)in children with juvenile idiopathic arthritis.Methods Seventy children with juvenile idiopathic arthritis were admitted to the Children’s Hospital of the Capital Institute of Pediatrics between October 2018 and October 2019,and they were divided into the control group and the research group according to a random number table,with 35 cases in each group.Inclusion criteria:six to16 years old,no allergic history of methotrexate or leflunomide.Exclusion criteria:immunodeficiency diseases,systemic infection diseases,hepatic or renal dysfunction,coagulation dysfunction and incomplete data,ect.The control group were treated with methotrexate tablets,and the research group were treated with leflunomide tablets on the basis of the control group.Both groups were treated for six months.The improvement of clinical symptoms and signs,immune function indexes,and serum cytokine levels before and after six months of treatment between the two groups were compared.The incidences of adverse reactions during the treatment in the two groups were counted.Count data were analyzed by chi-square test,measurement data were analyzed by t test.Results Compared with before treatment,after six months of treatment,the total score of juvenile arthritis disease activity scale(JADAS27)and serum immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM),MMP-3,IL-1β,and TNF-αlevels in the two groups decreased,and after six months of treatment,the research group were lower than the control group(t=21.789,14.927,7.133,3.611,4.209,3.480,4.760,all P<0.05).During the treatment,the incidence of adverse reactions in the research group(11.43%)and the control group(28.57%)were not obviously different(P>0.05).Conclusion Leflunomide combined with methotrexate in the treatment of juvenile idiopathic arthritis could significantly reduce the levels of serum MMP-3,IL-1β,and TNF-αin children,reduce the body's inflammation,and improve the immune function of children,improve clinical symptoms and signs with higher security.