艾拉莫德对难治性类风湿关节炎患者骨密度和血清B-ALP、CTX-I的机制分析

Analysis of the Mechanism of the Effect of Iguratimod on Bone Mineral Density and Serum B-ALP and CTX-I in Patients with Refractory Rheumatoid Arthritis

目的:探讨艾拉莫德对难治性类风湿关节炎患者骨密度和血清骨碱性磷酸酶(B-ALP)、I型胶原交联羧基末端肽(CTX-I)的机制。方法:选择2019年1月至2020年12月我院接诊的134例难治性类风湿关节炎患者,通过随机数表法分为观察组和对照组,每组67例。对照组给予甲氨蝶呤联合依那西普治疗,观察组给予艾拉莫德片联合依那西普治疗,均连续治疗12周。比较两组临床缓解率、实验室指标、类风湿关节炎患者病情评价(DAS28评分)、骨密度、血清B-ALP、CTX-I的变化和不良反应。结果:治疗后,观察组临床缓解率为90.00%,明显高于对照组72.50%(P<0.05);观察组红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)、抗环挂氨酸肽抗体(抗-CCP)表达和DAS28评分分别为(23.53±2.77)mm/h、(11.73±2.30)mg/L、(17.45±3.08)U/L、(43.22±7.17)RU/m L、(2.74±0.34)分,均明显低于对照组的(31.27±5.04)mm/h、(19.11±2.12)mg/L、(24.47±2.59)U/L、(55.23±7.44)RU/m L、(3.21±0.50)分,差异有统计学意义(P<0.05);观察组骨密度、血清B-ALP分别为(0.83±0.05)g/cm3、(117.02±15.65)U/L,均明显高于对照组(0.77±0.04)g/cm3、(101.19±9.59)U/L,观察组CTX-I为(0.36±0.04)μg/L,明显低于对照组(0.47±0.04)μg/L,差异有统计学意义(P<0.05);两组不良反应总发生率分别为4.44%和2.22%,差异无统计学意义(P>0.05)。结论:艾拉莫德联合依那西普治疗难治性类风湿关节炎效果显著,可明显改善骨密度、血清B-ALP、CTX-I的表达,提高临床缓解率,安全性好,值得应用推广。

Objective:To study the mechanism of the effect of iguratimod on bone mineral density and serum Bone alkaline phosphatase(B-ALP)and Type I collagen crosslinked carboxy terminal peptide(CTX-I)in patients with refractory rheumatoid arthritis.Methods:134 patients of refractory rheumatoid arthritis who received therapy from January 2019 to December 2020 in our hospital were selected as research objects,according to the random number table,they were divided into the observation group and the control group,67 cases in each group.The control group was treated with methotrexate combined with etanercept,and the observation group was treated with iguratimod combined with etanercept,they were continuous treatment 12 weeks.The clinical remission rate,laboratory indexes,disease evaluation(DAS28 score),bone mineral density,serum B-ALP,CTX-I and adverse reactions were compared between the two groups.Results:After treatment,the clinical remission rate in the observation group was 90.00%,significantly higher than the control group 72.50%(P<0.05);the erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rheumatoid factor(RF),anti cyclic peptide antibody(anti CCP)and DAS28 scores in the observation group were(23.53±2.77)mm/h,(11.73±2.30)mg/L,(17.45±3.08)U/L,(43.22±7.17)RU/m L,(2.74±0.34)scores respectively,which were significantly lower than the control group(31.27±5.04)mm/h,(19.11±2.12)mg/L,(24.47±2.59)U/L,(55.23±7.44)RU/m L,(3.21±0.50)scores,the difference were statistically significant(P<0.05);the bone mineral density and serum B-ALP in the observation group were(0.83±0.05)g/cm3,(117.02±15.65)U/L,which were significantly higher than the control group(0.77±0.04)g/cm3,(101.19±9.59)U/L,the CTX-I in the observation group were(0.36±0.04)μg/L,which were significantly lower than the control group(0.47±0.04)μg/L,the difference were statistically significant(P<0.05);the total incidence of adverse reactions in the two groups was 4.44%and 2.22%respectively,there were no significant difference(P>0.05).Conclusion:Iguratimod combined with etanercept is well for refractory rheumatoid arthritis,which can effectively improve the expression of BMD,serum B-ALP and CTX-I,improve the clinical remission rate,and has good safety,which is worth popularizing.