阿达木单抗与雷公藤多苷对甲氨蝶呤治疗反应不佳活动性类风湿关节炎患者的临床疗效与安全性

Clinical Study of Adalimumab and Tripterygium Glycosides in the Treatment of Active Rheumatoid Arthritis with Poor Response to Methotrexate Observation of Curative Effect and Safety

目的探讨阿达木单抗与雷公藤多苷对甲氨蝶呤(MTX)治疗反应不佳活动性类风湿关节炎(RA)患者的临床疗效与安全性。方法选取2018年2月至2020年5月朝阳市第二医院接诊的90例活动性RA患者作为研究对象,经MTX治疗反应不佳,按随机数字表法分为联合组和对照组,各45例。对照组行阿达木单抗治疗,联合组行阿达木单抗联合雷公藤多苷治疗。比较两组肿胀关节数、压痛关节数、晨僵时间、实验室指标、类风湿关节炎病情活动度评价表(DAS28)评分和治疗安全性。结果治疗后,联合组肿胀关节数、压痛关节数低于对照组,晨僵时间短于对照组,差异有统计学意义(P<0.05);联合组C反应蛋白(CRP)、类风湿因子(RF)、红细胞沉降率(ESR)、DAS28评分、不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论阿达木单抗联合雷公藤多苷治疗MTX治疗反应不佳RA具有较高的安全性,可控制疾病活动度,降低CRP、ESR、RF水平,缓解临床症状,促进患者病情恢复。

Objective To investigate the clinical efficacy and safety of adalimumab and tripterygium glycosides in the treatment of patients with active rheumatoid arthritis(RA)with poor response to methotrexate(MTX).Methods A total of 90 patients with active RA admitted to Chaoyang Second Hospital from February 2018 to may 2020 were selected as the research objects.All patients had poor response to MTX treatment.They were randomly divided into a combination group and a control group,with 45 cases in each group.The control group was treated with adalimumab,and the combination group was treated with adalimumab combined with tripterygium glycosides.The swelling joint number,tenderness joint number,morning stiffness time,laboratory indexes,disease activity(DAS28)score and treatment safety were compared between the 2 groups.Results After treatment,the number of swelling joints and tenderness joints in the combined group were lower than those in the control group,and the time of morning stiffness was shorter than that in the control group,with statistical difference(P<0.05);the levels of C-reactive protein(CRP),rheumatoid factor(RF),erythrocyte sedimentation rate(ESR),DAS28 score,and the incidence of adverse reactions in the combined group were lower than those in the control group,with statistical difference(P<0.05).Conclusion Adalimumab combined with Tripterygium wilfordii polyglycoside has high safety in the treatment of MTX with poor response.It can control disease activity,reduce CRP,ESR and RF levels,relieve clinical symptoms and promote the recovery of patients.