艾拉莫德对类风湿关节炎患者免疫功能及血清RF抗-CCP及Wnt-3α的影响

Effects of Iguratimod on Immune Function and Serum RF Anti-CCP and Wnt-3αin Patients with Rheumatoid Arthritis

目的:观察艾拉莫德在类风湿关节炎(RA)中的应用效果及对患者免疫功能、血清指标、功能状态等影响。方法:选取2019年1月至2020年6月收治的156例RA活动期患者,按住院顺序奇偶数法分成观察组与对照组各78例,对照组入组后予以甲氨蝶呤口服(每次10mg,1次/周),观察组在对照组基础上,联合艾拉莫德口服(每次25mg,2次/d),连续治疗12周,比较两组28个关节疾病活动度(DAS28)变化、治疗反应情况,分析患者治疗前后免疫功能指标(辅助性T细胞Th1、Th17及调节性T细胞)、血清指标[C反应蛋白(CRP)、类风湿因子(RF)、抗环瓜氨酸抗体(抗-CCP)、分泌型糖蛋白(Wnt)-3α]水平,采用健康评估问卷(HAQ)评价患者功能状态,并记录药物不良反应。结果:治疗后12周,两组DAS28值均较治疗前明显下降(P<0.05),且观察组降低幅度大于对照组(P<0.05);观察组总反应率97.44%,明显高于对照组(88.46%)(P<0.05)。两组Th1、Th17百分比均较治疗前明显下降(P<0.05),调节性T细胞百分比较治疗前明显升高(P<0.05),且观察组Th1、Th17百分比降低幅度大于对照组(P<0.05),调节性T细胞百分比升高幅度大于对照组(P<0.05)。两组血清CRP、RF、抗-CCP水平及Wnt-3α表达量均较治疗前明显下降(P<0.05),且观察组血清CRP、RF、抗-CCP水平及Wnt-3α表达量降低幅度均大于对照组(P<0.05)。两组HAQ评分均较治疗前明显下降(P<0.05),且观察组HAQ评分降低幅度大于对照组(P<0.05)。治疗组与对照组不良反应发生率比较差异无统计学意义(10.26%vs 6.41%,P>0.05)。结论:艾拉莫德用于RA治疗,可提高治疗反应率,有利于调节患者免疫功能、减轻炎症水平,促进功能状态恢复,且安全性较好。

Objective:To observe the application effects of iguratimod on rheumatoid arthritis(RA)and its effects on immune function,serum indexes and functional status of patients.Methods:A total of 156 patients with active RA admitted from January 2019 to June 2020 were selected and divided into observation group and control group according to the odd and even numbers of hospitalization order,with 78 cases in each group.Control group was given oral methotrexate(once for 10mg,once/week),and observation group was given oral iguratimod(once for 25 mg,twice/day)on the basis of control group,and they were continuously treated for 12 weeks.The 28 joint disease activity score(DAS28)and treatment response were compared between the two groups,and the levels of immune function indicators(helper T cells Th1 and Th17 and regulatory T cells)and serum indicators[C-reactive protein(CRP),rheumatoid factor(RF),anti-cyclic citrullinated peptide antibody(anti-CCP),secreted glycoprotein(Wnt)-3α]were analyzed before and after treatment,and Health Assessment Questionnaire(HAQ)was used to evaluate the functional status of patients,and adverse drug reactions were recorded.Results:12 weeks after treatment,the DAS28 value of the two groups was significantly lower than that before treatment(P<0.05),and the decrease in observation group was greater than that in control group(P<0.05).The total response rate in observation group was significantly higher than that in control group(97.44%vs 88.46%)(P<0.05).The percentages of Th1 and Th17 in the two groups were significantly lower than those before treatment(P<0.05)while the percentage of regulatory T cells was significantly higher than that before treatment(P<0.05),and the decreases of percentages of Th1 and Th17 in observation group were greater than those in control group(P<0.05),and the increase of percentage of regulatory T cells was greater than that in control group(P<0.05).The levels of serum CRP,RF and anti-CCP and expression level of Wnt-3αin the two groups were significantly lower than those before treatment(P<0.05),and the decreases of levels of serum CRP,RF and anti-CCP and expression level of Wnt-3αin observation group were greater than those in control group(P<0.05).The HAQ score of the two groups was significantly lower than that before treatment(P<0.05),and the decrease of HAQ score in observation group was greater than that in control group(P<0.05).There was no significant difference in the incidence rate of adverse reactions between observation group and control group(10.26%vs 6.41%)(P>0.05).Conclusion:Iguratimod in the treatment of RA can improve the response rate of treatment,help regulate the immune function,relieve the inflammation level,and promote the recovery of functional status,with good safety.