来氟米特与艾拉莫德联合治疗老年活动性类风湿关节炎患者的价值分析

Value Analysis of Leflunomide Combined with Elamud in the Treatment of Elderly Patients with Active Rheumatoid Arthritis

目的研究来氟米特与艾拉莫德二联疗法对RA患者的作用及对血清RF、CRP及IL-8、IL-17水平的影响。方法纳入某院从2017年3月1日-2019年3月15日收治的活动性RA患者92例进行研究。将其按照随机抽签法等分成二联组和单药组。单药组实施来氟米特口服治疗,二联组则于单药组的基础上联用艾拉莫德口服治疗。比较两组治疗前后关节功能指标水平,血清RF、CRP及IL-8、IL-17水平,骨代谢指标水平,不良反应发生情况。结果治疗后二联组关节肿胀数(0.89±0.21)个、关节压痛数(2.05±0.21)个、关节晨僵时间(30.01±4.76)分钟低于单药组的(1.78±0.35)个、(3.57±0.36)个、(48.67±5.21)分钟,两组比较差异具有统计学意义,P<0.05。治疗后二联组血清RF(126.92±33.10)IU/ml、CRP(4.05±1.30)mg/L及IL-8(245.29±20.49)ng/L、IL-17(78.05±14.92)pg/ml水平低于单药组的(204.39±45.27)IU/ml、(10.97±2.05)mg/L、(366.72±34.92)ng/L、(102.84±20.48)pg/ml,两组比较差异具有统计学意义,P<0.05。治疗后二联组NTX-1(11.20±4.01)ng/ml、β-CTX(0.44±0.11)pg/ml水平低于单药组的(18.81±6.20)ng/ml、(0.72±0.20)pg/ml,而TPINP水平(42.49±7.05)ng/ml,高于单药组的(36.78±6.51)ng/ml,两组比较差异具有统计学意义,P<0.05。二联组与单药组治疗后血清CCL18水平(62.32±8.15)ng/ml明显低于治疗前(156.32±12.49)ng/ml,且二联组(62.32±8.15)ng/ml低于对照组的(80.59±10.25)ng/ml,比较差异具有统计学意义,P<0.05。结论来氟米特与艾拉莫德二联疗法治疗活动性RA患者的效果显著,有利于改善其血清RF、CRP及IL-8、IL-17水平,促进骨代谢指标水平的改善,安全性较好,值得临床推广应用。

Objective To study the effects of leflunomide and iguratimod dual therapy on patients with active RA and to analyze the effects on serum RF, CRP, IL-8 and IL-17 levels. Methods 92 patients with active RA admitted to our hospital from March 1, 2017 to March 15, 2019 were included in the study. They were divided into combined group and single drug group according to random lottery. Leflunomide was administered orally in the single drug group, and iguratimod was added in the combined group. The levels of indicators of joint function, serum RF, CRP, IL-8 and IL-17, bone metabolism and adverse reactions in the two groups before and after treatment were compared. Results After treatment, the number of joint swelling(0.89±0.21), the number of joint tenderness(2.05±0.21), and the joint morning stiffness(30.01±4.76) in the combined group were significantly lower than those in the single drug group(1.78±0.35)(3.57±0.36)(48.67±5.21)(all P<0.05). After treatment, serum RF(126.92 ± 33.10)IU/ml, CRP(4.05 ± 1.30)mg/L, IL-8(245.29 ± 20.49)ng/L and IL-17(78.05 ±14.92)pg/ml levels in the two groups were significantly lower than those in the single drug group(204.39±45.27)IU/ml(10.97±2.05)mg/L(366.72±34.92)ng/L(102.84±20.48)pg/ml,(all P<0.05). After treatment, the levels of NTX-1(11.20±4.01)ng/ml and β-CTX(0.44±0.11)pg/ml in the combination group were significantly lower than those in the single drug group(18.81±6.20)ng/ml(0.72±0.20)pg/ml, while the levels of TPINP(42.49±7.05)ng/ml were significantly higher than those in the single drug group(36.78±6.51)ng/ml(all P<0.05). There were no significant differences in nausea and vomiting, elevated transaminase and incidence of oral ulcer between the combined group and the single drug group(all P<0.05). The serum LEVEL of CCL18(62.32±8.15)ng/ml after treatment was significantly lower in the combined group(62.32±8.15)ng/ml and the single drug group than before treatment, and the level of CCL18 in the combined group was lower than control group(80.59±10.25)ng/ml(all P<0.05). Conclusion Leflunomide combined therapy with iguratimod has a significant effect on the treatment of patients with active RA, which is conducive to improving their serum RF, CRP, IL-8 and IL-17 levels, promoting the improvement of bone metabolism index levels, and is safe and worthy of clinical promotion and application.