甲氨蝶呤联合免疫吸附治疗类风湿关节炎的疗效及对患者血清抗CCP抗体、抗MCV抗体和EOS水平的影响

Efficacy of methotrexate combined with immunoadsorption in the treatment of rheumatoid arthritis and its effect on serum anti-CCP antibody,anti-MCV antibody,and EOS levels

目的观察甲氨蝶呤联合免疫吸附治疗类风湿关节炎的效果,并探讨其对患者血清抗环瓜氨酸肽(CCP)抗体、抗突变型瓜氨酸波形蛋白(MCV)抗体和嗜酸性粒细胞(EOS)水平的影响。方法采用随机数表法将2017年1月至2020年8月期间西安市第五医院风湿科收治的106例类风湿关节炎患者分为对照组和观察组,每组53例。对照组患者采用甲氨蝶呤治疗,观察组患者实施甲氨蝶呤联合免疫吸附治疗,均治疗12周。比较两组患者治疗前后的临床症状(晨僵时间、关节肿胀、关节疼痛、屈伸不利)、血清CCP抗体、MCV抗体和EOS水平,并比较两组患者的临床疗效及治疗期间的不良反应发生情况。结果治疗后观察组的晨僵时间明显少于对照组[(47.11±3.36)min vs(52.22±2.43)min],差异有统计学意义(P<0.05);观察组关节肿胀、关节疼痛、屈伸不利评分为(1.21±2.08)分、(1.11±1.05)分、(0.97±1.02)分,分别低于对照组的(1.88±1.06)分、(1.56±1.01)分、(1.44±1.28)分,差异有统计学意义(P<0.05);观察组血清抗CCP抗体、抗MCV抗体和EOS水平分别为(57.11±2.36)U/mL、(42.31±28.08)U/mL、(0.72±0.32)%,分别低于对照组的(63.22±3.43)U/mL、(53.58±27.06)U/mL、(0.91±0.59)%,差异有统计学意义(P<0.05);观察组的治疗总有效率高于对照组(88.68%vs 73.58%),差异有统计学意义(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论甲氨蝶呤联合免疫吸附治疗类风湿关节炎能缓解患者的临床症状,降低血清抗CCP抗体、抗MCV抗体和EOS水平,临床治疗效果显著,且具有一定的安全性,值得临床推广应用。

Objective To observe the effect of methotrexate combined with immunoadsorption in the treatment of rheumatoid arthritis,and to explore the effects of methotrexate combined with immunoadsorption on serum anti-cyclic citrulline peptide(CCP)antibody,anti-mutant citrulline vimentin(MCV)antibody,and eosinophils(EOS)levels of patients.Methods A total of 106 patients with rheumatoid arthritis admitted to the Department of Rheumatology,Xi’an Fifth Hospital from January 2017 to August 2020 were divided into a control group and an observation group by random number table method,with 53 patients in each group.The control group was treated with methotrexate,and the observation group was treated with methotrexate combined with immunoadsorption for 12 weeks.The clinical symptoms(morning stiffness time,joint swelling,joint pain,adverse flexion and extension),serum CCP antibody,MCV antibody,and EOS levels were compared between the two groups before and after treatment.The clinical efficacy and the occurrence of adverse reactions during treatment were compared between the two groups.Results After treatment,the morning stiffness time of the observation group was significantly less than that of the control group:(47.11±3.36)min vs(52.22±2.43)min,P<0.05,and the difference was statistically significant(P<0.05).The joint swelling,joint pain,and adverse flexion and extension scores in the observation group were(1.21±2.08)points,(1.11±1.05)points,(0.97±1.02)points,significantly lower than(1.88±1.06)points,(1.56±1.01)points,(1.44±1.28)points in the control group,and the differences were statistically significant(P<0.05).The levels of anti-CCP antibody,anti-MCV antibody,and EOS in the observation group were(57.11±2.36)U/mL,(42.31±28.08)U/mL,and(0.72±0.32)%,which were significantly lower than(63.22±3.43)U/mL,(53.58±27.06)U/mL,and(0.91±0.59)% in the control group,respectively(P<0.05).The total effective rate of the observation group was higher than that of the control group,and the difference was statistically significant(88.68%vs 73.58%,P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Methotrexate combined with immunoadsorption in the treatment of rheumatoid arthritis can relieve the clinical symptoms of patients,reduce the serum anti-CCP antibody,anti-MCV antibody and EOS levels,and has a significant clinical treatment effect,with a certain degree of safety.It is worthy of clinical application.