塞来昔布联合甲氨蝶呤及硫酸羟氯喹治疗类风湿性关节炎的临床观察

Clinical observation of celecoxib combined with methotrexate and hydroxychloroquine sulfate in the treatment of rheumatoid arthritis

目的观察塞来昔布联合甲氨蝶呤及硫酸羟氯喹治疗类风湿性关节炎(RA)对患者血脂、血清免疫球蛋白(Ig)及炎性因子的影响。方法选取2015年4月—2017年5月福建省立医院收治的RA患者81例,采用随机数字表法分为观察组(n=41)和对照组(n=40)。观察组采用塞来昔布联合甲氨蝶呤及硫酸羟氯喹治疗,对照组采用甲氨蝶呤联合硫酸羟氯喹治疗,2组均治疗6个月。比较2组患者治疗前后症状改善情况、血脂[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)]、血清Ig[免疫球蛋白M(IgM)、免疫球蛋白G(IgG)]、炎性因子[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]水平及不良反应。结果治疗6个月后,2组患者关节肿胀数目、关节压痛数目均少于治疗前,僵硬时间均短于治疗前,且观察组变化幅度大于对照组(P<0.05);2组患者TC、TG、LDL-C、IgM、IgG、IL-6、TNF-α水平均低于治疗前,且观察组低于对照组(P<0.05);观察组患者不良反应总发生率为12.20%,对照组患者不良反应总发生率为22.50%,2组比较差异无统计学意义(χ^(2)=1.503,P=0.220)。结论塞来昔布联合甲氨蝶呤及硫酸羟氯喹治疗RA,可改善患者临床症状,调节血脂,且安全性高,其机制可能与下调IgM、IL-6、IgG、TNF-α表达有关。

Objective To observe the effects of celecoxib combined with methotrexate and hydroxychloroquine sulfate on blood lipid,serum immunoglobulin(Ig)and inflammatory factors in patients with rheumatoid arthritis(RA).Methods A total of 81 RA patients admitted to Fujian Provincial Hospital from April 2015 to May 2017 were randomly divided into observation group(n=41)and control group(n=40)by random number table method.The observation group was treated with celecoxib combined with methotrexate and hydroxychloroquine sulfate,while the control group was treated with methotrexate combined with hydroxychloroquine sulfate,both groups were treated for 6 months.The improvement of symptoms,serum lipids[total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)],serum Ig[immunoglobulin M(IgM),immunoglobulin G(IgG)],inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)]levels and adverse reactions were compared between two groups before and after treatment.Results After 6 months of treatment,the number of joint swelling and joint tenderness in two groups were less than before,and the duration of stiffness were shorter than before,and the range of change in observation group was greater than that in control group(P<0.05).After 6 months of treatment,the levels of TC,TG,LDL-C,IgM,IgG,IL-6 and TNF-αin two groups were lower than before,and the observation group was lower than the control group(P<0.05).The total incidence of adverse reactions was 12.20%in the observation group and 22.50%in the control group,and there was no significant difference between the two groups(χ^(2)=1.503,P=0.220).Conclusion Celecoxib combined with methotrexate and hydroxychloroquine sulfate in the treatment of RA can improve clinical symptoms and regulate blood lipidawith high safety,and the mechanism may be related to the down-regulation of the expression of IgM,IL-6,IgG and TNF-α.