羟氯喹联合甲氨蝶呤治疗类风湿关节炎临床观察

Clinical Observation of Hydroxychloroquine Combined with Methotrexate in the Treatment of Rheumatoid Arthritis

目的探讨羟氯喹联合甲氨蝶呤治疗类风湿关节炎(RA)的临床疗效,以及对患者骨代谢、炎性因子、D-二聚体(D-D)、纤维蛋白原(Fib)水平的影响。方法选取医院风湿免疫科2016年7月至2017年7月收治的RA患者180例,按随机数字表法分为对照组和联合组,各90例。两组患者均予甲氨蝶呤片口服,联合组患者加服羟氯喹片。两组均治疗24周。结果联合组总有效率为81.11%,显著高于对照组的66.67%(P<0.05);联合组患者治疗后的总Ⅰ型胶原氨基端延长肽、骨钙素N端中分子水平均显著高于对照组,β-胶原降解产物水平、白细胞介素6、肿瘤坏死因子-α、粒细胞集落刺激因子、D-D及Fib水平均显著低于对照组(P<0.05);联合组与对照组不良反应发生率相当(33.33%比34.44%,P>0.05)。结论羟氯喹联合甲氨蝶呤治疗RA,可改善患者的骨代谢,降低机体炎性反应水平,减少D-D及Fib含量。

Objective To investigate the clinical efficacy of hydroxychloroquine combined with methotrexate in the treatment of patients with rheumatoid arthritis(RA)and the effect on bone metabolism,inflammatory factors,D-Dimer(D-D)and fibrinogen(Fib).Methods A total of 180 patients with RA admitted to our hospital from July 2016 to July 2017 were selected and divided into the control group and the combined group according to the random number table method,90 cases in each group.The patients in the two groups were given Methotrexate Tablets,on this basis,the patients in the combined group were given Hydroxychloroquine Sulfate Tablets.Both groups were treated for 24 weeks.Results The total effective rate of the combined group was 81.11%,which was significantly higher than 66.67%of the control group(P<0.05).After treatment,the levels of propeptide of typeⅠprocollagen(T-PINP)and N-mid osteocalcin(N-MID)in the combined group were significantly higher than those in the control group,while the levels ofβ-C-terminal telopeptide of typeⅠcollagen(β-CTX),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),macrophage-stimulating factor(M-CSF),D-D and Fib in the combined group were significantly lower than those in the control group(P<0.05).The incidence of adverse reactions in the combined group was similar to that in the control group(33.33%vs.34.44%,P>0.05).Conclusion Hydroxychloroquine combined with methotrexate in the treatment of RA can improve bone metabolism,reduce the inflammatory reaction and the contents of D-D and Fib.