双醋瑞因治疗老年人类风湿关节炎的效果及作用机制

Effect and Mechanism of Diacerein in the Treatment of Rheumatoid Arthritis in the Elderly

目的:探讨双醋瑞因治疗老年人类风湿关节炎的效果及作用机制。方法:选取2018年1月—2019年6月河南中医药大学第三附属医院收治的94例老年人类风湿关节炎患者作为研究对象,通过采用前瞻性研究分组法分为联合组(双醋瑞因+甲氨蝶呤与来氟米特)和对照组(甲氨蝶呤与来氟米特),每组各47例,疗程均为6个月,对比两种方法的临床效果。结果:治疗后,联合组患者ACR70比例高于对照组,差异有统计学意义(χ^(2)=4.502,P<0.05);两组患者的ACR20、ACR50所占比例,差异无统计学意义(χ^(2)=0.301、1.167,P>0.05);治疗后,联合组的关节肿胀数目、关节压痛数目、晨僵时间、双手握力均低于对照组;治疗后,联合组的血清基质金属蛋白酶13(MMP-13)、可溶性细胞黏附分子-1(sI⁃CAM-1)、白红胞介素-10(L-10)、白红胞介素-1(IL-1)、白胞介素6(IL-6)、肿瘤细胞坏死因子-α(TNF-α)的水平均低于对照组。结论:双醋瑞因联合甲氨蝶呤与来氟米特治疗老年人类风湿关节炎效果可靠,能进一步降低血清MMP-13、sICAM-1、IL-10、IL-1、IL-6、TNF-α的水平。

Objective:To investigate the effect and mechanism of diacerein in the treatment of rheumatoid arthritis in the elderly.Methods:A total of 94 elderly patients with rheumatoid arthritis admitted to the hospital from January 2018 to June 2019 were se⁃lected.According to the prospective study grouping method,the patients were divided into combination group(diacerein+metho⁃trexate and leflunomide)and control group(methotrexate and leflunomide),with 47 cases in each group.The course of treatment was 6 months,and the clinical effects of the two methods were compared.Results:After treatment,the ratio of ACR70 in the com⁃bined group was higher than that in the control group,and the difference was statistically significant(χ^(2)=4.502,P<0.05).There was no statistically significant difference in the proportion of ACR20 and ACR50 patients between the two groups(χ^(2)=0.301,1.167,P>0.05).After treatment,the number of joint swelling,the number of joint tenderness,the time of morning stiffness,and the grip strength of both hands in the combined group were lower than those in the control group.After treatment,the serum levels of MMP-13,sICAM-1,IL-10,IL-1,IL-6 and TNF-αin the combination group were lower than those in the control group.Conclu⁃sion:Diacerein combined with methotrexate and leflunomide has reliable effect in the treatment of elderly rheumatoid arthritis,and can further reduce serum level of MMP-13,sICAM-1,IL-10,IL-1,IL-6,TNF-α.