艾拉莫德联合甲氨蝶呤和羟氯喹对女性类风湿关节炎患者骨密度影响的临床研究

Effect of iguratimod combined with methotrexate and hydroxychloroquine on bone mineral density in female patients with rheumatoid arthritis

目的探讨甲氨蝶呤(MTX)、羟氯喹(HCQ)联合艾拉莫德(IGU)对女性类风湿关节炎(RA)患者骨密度的影响。方法选择2018年10月至2019年10月浙江省人民医院就诊的女性RA患者,采用MTX、HCQ联合IGU治疗,观察患者治疗前后的相关血清学指标如CRP、ESR、类风湿因子(RF)、抗环瓜氨酸肽(CCP)抗体等以及骨密度、骨代谢指标的变化并作比较,评估治疗安全性。结果与治疗前比较,治疗12周ESR、补体3,治疗24周RF、CRP、ESR,治疗36周RF、ESR,治疗48周RF、CRP、ESR、抗CCP抗体均较低,差异均有统计学意义(均P<0.05);治疗24周患者左股骨颈以及L_(1)~L_(4)骨密度值,治疗48周各部位(左股骨颈、左全髋、L_(1)~L_(4))骨密度值均较高,差异均有统计学意义(均P<0.05)。与治疗24周比较,治疗48周各部位骨密度值均较高,β-CTX较低,差异均有统计学意义(均P<0.05)。结论MTX、HCQ联合IGU治疗能够有效降低女性RA患者的炎症指标,显著改善骨密度,且安全性良好。

Objective To explore the effects of iguratimod(IGU)combined wih methotrexate(MTX)and hydroxychlo-roquine(HCQ)on bone mineral density in female patients with rheumatoid arthritis(RA).Methods Thirty seven female RA patients received IGU combined MTX and HCQ treatment in Zhejiang Provincial People's Hospital from October 2018 to October 2019.The relevant serological indicators including CRP,ESR,rheumatoid factor(RF),anti-inflammatory cyclic citrullinated peptide(CCP)antibodies,as well as bone mineral density(BMD)and bone metabolism indexes of patients were determined before and after treatment.Results Compared with those before treatment,ESR,complement C3 after 12 weeks of treatment,RF,CRP,ESR after 24 weeks of treatment,RF,ESR after 36 weeks of treatment,and RF,CRP,ESR,and anti-CCP antibodies 48 weeks of treatment were significantly decreased(all P<0.05).The BMD values of left femoral neck and L_(1)-L_(4) in patients 24 weeks after treatment,and BMD values of left femoral neck,left total hip,L_(1)-L_(4) at 48 weeks after treatment were significantly increased(all P<0.05).Compared with those 24th week after treatment,the BMD of each site was significantly increased and the β-CTX was significantly decreased at 48th week after treatment(all P<0.05).Conclusion The combination of MTX,HCQ and IGU can effectively reduce the disease activity,reduce inflammation indicators,and significantly improve bone mineral density with good safety in treatment of female RA patients.