艾拉莫德联合甲氨蝶呤治疗类风湿关节炎对外周血核因子κB受体活化因子配体和护骨因子的影响

Effects of iguratimod combined with methotrexate on peripheral blood RANKL and OPG in treatment of rheumatoid arthritis

目的探讨类风湿关节炎(RA)患者经艾拉莫德联合甲氨蝶呤(MTX)治疗24周后外周血核因子κB受体活化因子配体(RANKL)、护骨因子(OPG)浓度的变化及临床疗效。方法按照入组标准、排除标准选择研究组20例及与基本资料匹配的对照组OPG 13例,比较治疗24周后外周血RANKL、OPG浓度,及C反应蛋白(CRP)、红细胞沉降率(ESR)、肿痛关节数、28个关节疾病活动指数(DAS28)等疾病活动度指标的变化。结果①研究组和对照组治疗24周后外周血RANKL浓度、OPG浓度出现下降(P<0.05),且研究组治疗后OPG/RANKL比值升高(P<0.05);对照组治疗后OPG/RANKL比值下降,但前后对比差异无统计学意义(P>0.05)。2组治疗后比较,RANKL浓度、OPG浓度和OPG/RANKL比值差异均无统计学意义(P>0.05)。②研究组和对照组治疗24周后DAS28均出现明显下降(P<0.01),且对照组DAS28下降程度多于研究组,2组差异有统计学意义(P<0.05)。结论艾拉莫德联合MTX可能对RA患者骨破坏有抑制作用;且能改善关节症状,降低疾病活动度。

Objective To determine the changes of OPG and RANKL in peripheral blood of patients with rheumatoid arthritis(RA)at 24 weeks after the treatment of iguratimod and methotrexate(MTX),and to investigate its clinical effect.Methods According to the inclusion criteria and exclusion criteria,the study group(n=20)and the control group(n=13)matched with the basic data were included in the study.The changes in the disease activity indexes at 24 weeks after the treatment,such as RANKL and OPG levels,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),number of joint swelling and pain,and disease activity score in 28 joints(DAS28)were compared.Results①The peripheral blood RANKL and OPG levels decreased in the study group and control group at 24 weeks after the treatment(P<0.05).The OPG/RANKL ratio increased in the study group after the treatment(P<0.05).The OPG/RANKL ratio decreased in the control group after the treatment,and there was no statistically significant difference compared with that at baseline(P>0.05).There were no statistically significant differences in the RANKL and OPG levels and OPG/RANKL ratio between the two groups after the treatment(all P>0.05).②At 24 weeks after the treatment,DAS28 decreased significantly in the study group and control group(P<0.01),whereas the decrease of DAS28 in the control group was more than that in the study group,with statistical significance between the two groups(P<0.05).Conclusion Iguratimod combined with MTX may inhibit bone destruction in RA patients,which may improve joint symptoms and reduce disease activity.