鹿瓜多肽注射液、骨化三醇联合来氟米特在老年类风湿性关节炎合并骨质疏松中的应用

Application of Lugua Polypeptide Injection,Calcitriol Combined with Leflunomide in Treatment of Senile Rheumatoid Arthritis with Osteoporosis

目的观察鹿瓜多肽注射液、骨化三醇联合来氟米特在老年类风湿性关节炎合并骨质疏松中的临床疗效。方法选取2016年10月―2018年10月收治的60例老年类风湿性关节炎合并骨质疏松患者,按随机数字表法分为观察组与对照组,每组30例。对照组给予骨化三醇联合来氟米特治疗,观察组在对照组治疗的基础上联合穴位注射鹿瓜多肽注射液治疗。两组均以1周为1个疗程,共治疗3个疗程。比较两组治疗后总有效率,治疗前与治疗3个疗程后膝关节滑膜液中滑膜骨形态发生蛋白(BMPs)水平与基质金属蛋白酶-1(MMP-1)表达水平、骨密度T值、血清中Ig M型类风湿因子(RF)水平、血沉(ESR)水平及治疗期间不良反应总发生率。结果观察组治疗后整体疗效优于对照组(P<0.05),差异有统计学意义;治疗3个疗程后,两组关节滑液中BMPs水平较本组治疗前升高、MMP-1阳性表达率均较本组治疗前降低(P<0.05)。观察组治疗3个疗程后关节滑液中BMPs水平高于对照组、MMP-1阳性表达率低于对照组(P<0.05);治疗3个疗程后,两组血清ESR、RF均较本组治疗前减小(P<0.05)。观察组治疗3个疗程后T值较治疗前增大(P<0.05),对照组未见明显变化(P>0.05);观察组治疗后T值高于对照组,血清ESR、RF低于对照组(P<0.05);两组治疗期间不良反应总发生率比较差异无统计学意义(P>0.05)。结论穴位注射鹿瓜多肽联合西医可有效改善RA患者临床症状,疗效优于单纯西医治疗,并促进BMPs合成、抑制MMP-1过度表达,降低血清ESR、RF并可改善骨质疏松,是治疗老年类风湿性关节炎合并骨质疏松的理想方案。

Objective To observe the clinical efficacy of Lugua polypeptide injection,calcitriol combined with leflunomide in the treatment of elderly rheumatoid arthritis with osteoporosis.Methods A total of 60 elderly patients with rheumatoid arthritis and osteoporosis who were admitted to our hospital from October 2016 to October 2018 were selected and divided into observation group and control group according to a random number table,with 30 cases in each group.The control group took calcitriol combined with leflunomide,and the observation group was combined with acupoint injection of Lugua Polypeptide Injection on the basis of the control group.Both groups took 1 week as a course of treatment,a total of 3 courses.The total effective rate,the level of synovial bone morphogenetic protein(BMPs) and the expression level of matrix metalloproteinase-1(MMP-1),bone mineral density T value,and the level of synovial bone morphogenetic protein(BMPs) in the synovial fluid of the knee joint before treatment and 3 courses of treatment were compared between the two groups.Serum Ig M rheumatoid factor(RF) levels and erythrocyte sedimentation rate(ESR) and the total incidence of adverse reactions during treatment.Results The overall curative effect of the observation group was better than that of the control group after treatment,and the difference was statistically significant(P<0.05);after 3 courses of treatment,the level of BMPs in the synovial fluid of the two groups increased compared with before treatment,and the positive expression rate of MMP-1 All were lower than before treatment(P<0.05).The level of BMPs in the synovial fluid of the observation group after 3 courses of treatment was higher than that of the control group,and the positive expression rate of MMP-1 was lower than that of the control group(P<0.05);after 3 courses of treatment,the serum ESR and RF of the two groups were higher than those of the treatment group.Decrease before(P<0.05).The T value of the observation group after 3 courses of treatment was higher than before treatment(P<0.05),and there was no significant change in the control group(P >0.05);the T value of the observation group after treatment was higher than that of the control group,and the serum ESR and RF were lower In the control group(P<0.05);there was no significant difference in the total incidence of adverse reactions during the treatment period between the two groups(P>0.05).Conclusion Acupoint injection of Lugua polypeptide combined with Western medicine can effectively improve the clinical symptoms of RA patients.The curative effect is better than that of Western medicine alone.It also promotes the synthesis of BMPs,inhibits the overexpression of MMP-1,reduces serum ESR and RF,and improves osteoporosis.It is a treatment The ideal solution for senile rheumatoid arthritis with osteoporosis.