羟氯喹联合来氟米特治疗老年类风湿关节炎对患者滑膜液炎症因子及信号通路调控关节软骨重建的影响

Effects of hydroxychloroquine combined with leflunomide on synovial fluid inflammatory factors and signaling pathways regulating articular cartilage reconstruction in elderly patients with rheumatoid arthritis

目的探讨羟氯喹联合来氟米特治疗老年类风湿关节炎(RA)对患者滑膜液炎症因子及信号通路调控关节软骨重建的影响。方法选取2019年2月至2021年5月于本院治疗的83例老年RA患者作为研究对象,按抽签法分为联合组(n=43)和对照组(n=40)。对照组采用羟氯喹治疗,联合组在对照组基础上联合来氟米特治疗。比较两组治疗前后临床症状[晨僵时间、疾病活动度评分28(DAS28)、压痛关节数、肿胀关节数]、滑膜液炎症因子[基质金属蛋白酶-3(MMP-3)、丙二醛(MDA)、类风湿因子(RF)]、信号通路表达[核因子-κB(NF-κB)、β-连环蛋白(β-catenin)、Wnt蛋白7B抗体(Wnt7b)]及不良反应发生情况。结果治疗后,两组晨僵时间短于治疗前,DAS28评分低于治疗前,压痛关节数、肿胀关节数均少于治疗前,且联合组晨僵时间短于对照组,DAS28评分低于对照组,压痛关节数、肿胀关节数均少于对照组,差异有统计学意义(P<0.05)。治疗后,两组MMP-3、RF、MDA水平均低于治疗前,且联合组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组NF-κB、β-catenin、Wnt7b均低于治疗前,且联合组低于对照组,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。结论氯喹联合来氟米特治疗老年RA患者疗效显著,可降低滑膜液炎症因子水平,调控基因通路,安全性较高,值得临床推广应用。

Objective To investigate the effect of hydroxychloroquine combined with leflunomide on synovial fluid inflammatory factors and signaling pathways regulating articular cartilage reconstruction in elderly patients with rheumatoid arthritis(RA).Methods 83 elderly patients with RA treated at our hospital from February 2019 to May 2021 were selected as the research subjects,and they were divided into the combined group(n=43)and the control group(n=40)by lottery method.The control group was treated with hydroxychloroquine,and the combined group was treated with leflunomide on the basis of the control group.The clinical signs and symptoms(morning stiffness time,disease activity score 28[DAS28],number of tender joints,number of swollen joints),synovial fluid inflammatory factors(matrix metalloproteinase-3[MMP-3],malondialdehyde[MDA],rheumatoid factor[RF]),signaling pathway expression(nuclear factor-κB[NF-κB],β-catenin,Wnt protein 7b antibody[Wnt7b])and adverse reactions were compared between the two groups before and after treatment.Results After treatment,the morning stiffness time of the two groups was shorter than before treatment,DAS28 score was lower than before treatment,the number of tender joints and swollen joints were lower than before treatment,and the morning stiffness time in the combined group was shorter than the control group,the DAS28 score was lower than the control group,the number of tender joints and swollen joints were lower than the control group,the differences were statistically significant(P<0.05).After treatment,the levels of MMP-3,RF and MDA in the two groups were lower than before treatment,and the combined group was lower than the control group,the differences were statistically significant(P<0.05).After treatment,NF-κB,β-catenin and Wnt7b in the two groups were lower than before treatment,and combined group was lower than control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Hydroxychloroquine combined with leflunomide is effective in the treatment of elderly patients with RA,which can reduce the levels of inflammatory factors in synovial fluid,regulate gene pathways,and has high safety,which is worthy of clinical application.