汉防己甲素联合环磷酰胺治疗类风湿关节炎合并肺间质病变的临床疗效评价

Clinical efficacy of Tetrandrine and Cyclophosphamide in treatment of rheumatoid arthritis complicated with interstitial lung disease

目的探讨汉防己甲素联合环磷酰胺治疗类风湿关节炎合并肺间质病变的临床效果。方法收集盐城市第一人民医院类风湿关节炎合并肺间质病变患者110例, 随机分成环磷酰胺组(55例)和联合用药组(55例), 环磷酰胺组给予环磷酰胺冲击治疗, 联合用药组给予汉防己甲素联合环磷酰胺治疗。治疗前均完成支气管镜下肺活检、肺泡灌洗、高分辨率CT(HRCT)评分、临床放射学和生理学评分, 治疗6个月后随访, 复查并比较两组患者的临床放射学和生理学评分。结果经治疗后联合用药组的临床放射学和生理学评分、肺功能、呼吸困难评分和动脉血氧分压改善明显, 优于环磷酰胺组, P<0.05;环磷酰胺组治疗有效率36%(18/50), 联合用药组有效率69%(35/51), P<0.05;在肺泡灌洗液中, 联合用药组的中性粒细胞数下降幅度较环磷酰胺组明显, P<0.05。治疗期间, 联合用药组患者未发生与汉防己甲素相关的不良反应。不良反应主要体现在环磷酰胺上, 尤其是呼吸系统感染, 联合用药组为5.5%(3/55)低于环磷酰胺组18.2%(10/55), P<0.05。结论汉防己甲素联合环磷酰胺冲击治疗类风湿关节炎合并肺间质病变优于单用环磷酰胺, 且药物安全性好。

Objective To investigate the clinical efficacy of Tetrandrine combined with Cyclophosphamide in the treatment of rheumatoid arthritis(RA)complicated with interstitial lung disease(ILD).Methods A total of 110 patients with RA complicated with ILD admitted to Yancheng First Municipal People’s Hospital were randomly divided into Cyclophosphamide group and combination therapy group(n=55 each).The Cyclophosphamide group was given Cyclophosphamide pulse therapy.The combination therapy group was given Tetrandrine and Cyclophosphamide.At baseline,bronchoscopic lung biopsy,alveolar lavage,high-resolution CT(HRCT)scoring,clinical radiological and physiological scoring were performed.At 6 months after the treatment,all patients were followed up,re-reviewed,and compared for clinical radiological and physiological scores between the two groups.Results After the treatment,the clinical radiological and physiological scores,pulmonary function,dyspnea score,and arterial partial pressure of oxygen in the combination therapy group were improved more significantly compared with the Cyclophosphamide group(all P<0.05).The response rate in the Cyclophosphamide group and combination therapy group was 36%(18/50)vs 69%(35/51)(P<0.05).In the alveolar lavage fluid,the neutrophil count in the combination therapy group was much more lowered than that in the Cyclophosphamide group(P<0.05).During the treatment,there were no Tetrandrine-related adverse reactions in the combination therapy group.The adverse reactions were mainly related to Cyclophosphamide,especially respiratory infections.The incidence of adverse reactions in the combination therapy group was lower than that in the Cyclophosphamide group[5.5%(3/55)vs 18.2%(10/55)](P<0.05).Conclusion Tetrandrine combined with Cyclophosphamide pulse therapy is more effective than cyclophosphamide alone in the treatment of RA and ILD,with good medication safety.