臭氧大自血疗法联合甲氨蝶呤治疗类风湿关节炎的临床疗效

Clinical study of different concentrations of ozone macroautoblood therapy on patients with rheumatoid arthritis

目的探讨不同浓度臭氧大自血疗法治疗类风湿关节炎(rheumatoid arthritis,RA)患者的临床疗效。方法选取郑州人民医院2022年6月至2023年6月收治的90例RA患者,采用随机数字表法分为甲氨蝶呤组(甲氨蝶呤片治疗)、低浓度臭氧组(30μg/mL臭氧联合甲氨蝶呤治疗)和高浓度臭氧组(50μg/mL臭氧联合甲氨蝶呤治疗),各30例。治疗4周和12周后,比较两组患者的临床疗效、健康状况[健康评估问卷(HAQ)]、疼痛程度[视觉模拟量表(VAS)]、疾病活动度[28个关节疾病活动度指数(DAS28)]、炎性因子[红细胞沉降率(ESR)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、1L-10、IL-17]和免疫功能指标[类风湿因子(RF)、血清抗环瓜氨酸肽抗体(抗CCP)、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平]。结果治疗12周后,三组治疗总有效率比较,差异显著(P<0.05),高浓度臭氧组总有效率明显高于低浓度臭氧组和甲氨蝶呤组(P<0.05);治疗4周和12周后,三组HAQ评分、VAS评分、DAS28评分均呈逐渐下降趋势,同时间点三组间比较,差异显著(P<0.05),且高浓度臭氧组HAQ评分、VAS评分、DAS28评分均明显低于低浓度臭氧组和甲氨蝶呤组(P<0.05);治疗4周和12周后,三组ESR、血清CRP、TNF-α、IL-6、IL-10、IL-17水平均呈逐渐下降趋势,同时间点三组间比较,差异显著(P<0.05),且高浓度臭氧组ESR、血清CRP、TNF-α、IL-6、IL-10、IL-17水平均明显低于低浓度臭氧组和甲氨蝶呤组(P<0.05);治疗4周和12周后,三组RF、抗CCP、IgA、IgG、IgM水平均呈逐渐下降趋势,同时间点三组间比较,差异显著(P<0.05),且高浓度臭氧组RF、抗CCP、IgA、IgG、IgM水平均明显低于低浓度臭氧组和甲氨蝶呤组(P<0.05);治疗期间,三组间不良反应发生率比较,无显著性差异(P>0.05)。结论与单独采用甲氨蝶呤和低浓度(30μg/mL)臭氧治疗比较,较高浓度(50μg/mL)臭氧大自血疗法治疗RA的疗效更好,可通过减轻患者的炎性反应,提升免疫功能,进一步减轻患者的疼痛程度、降低疾病活动度,改善患者的健康状况。

Objective To investigate the effect of different concentrations of ozone macroautoblood therapy on patients with rheumatoid arthritis(RA).Methods Ninety patients with RA admitted to Zhengzhou People's Hospital from From June 2022 to June 2023 were selected and divided into methotrexate group(treated with methotrexate tablets),low-concentration ozone group(treated with 30μg/mL ozone combined with methotrexate)and high-concentration ozone group(treated with 50μg/mL ozone combined with metho⁃trexate)by random number table method,with 30 cases in each group.After 4 and 12 weeks of treatment,clinical effi⁃cacy,health status[health assessment questionnaire(HAQ)],pain degree[visual analog scale(VAS)],disease ac⁃tivity[28 joint disease activity index(DAS28)],inflammatory factors[erythrocyte precipitation rate(ESR),C-reac⁃tive protein(CRP),and tumor necrosis factor-α(TNF-α),interleukin(IL)-6,1L-10,IL-17]and immune function indicators[rheumatoid factor(RF),serum anti-cyclic citrullinated peptide antibody(anti-CCP),immuno⁃globulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM)levels]were compared between the two groups.Results After 12 weeks of treatment,the total effective rate of the three groups was significantly different(P<0.05),and the total effective rate of the high concentration ozone group was significantly higher than that of the low concentration ozone group and methotrexate group(P<0.05).After 4 and 12 weeks of treatment,the HAQ score,VAS score and DAS28 score in the three groups showed a gradually decreasing trend,and the difference was significant among the three groups at the same time point(P<0.05),and the HAQ score,VAS score and DAS28 score in the high concentration ozone group were significantly lower than those in the low concentration ozone group and methotrexate group(P<0.05).After 4 and 12 weeks of treatment,the levels of ESR,serum levels of CRP,TNF-α,IL-6,IL-10 and IL-17 in the three groups showed a gradually decreasing trend,and the difference was significant(P<0.05).ESR,serum levels of CRP,TNF-α,IL-6,IL-10 and IL-17 in high concentration ozone group were significantly lower than those in low concentration ozone group and methotrexate group(P<0.05).After 4 and 12 weeks of treatment,the levels of RF,anti-CCP,IgA,IgG and IgM in the three groups were gradually decreased,and the differences were significant among the three groups at the same time point(P<0.05),and the levels of RF,anti-CCP,IgA,IgG and IgM in the high concentration ozone group were significantly lower than those in the low concentration ozone group and methotrexate group(P<0.05).During treatment,there was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion Compared with methotrexate alone and low concentration(30μg/mL)ozone group,high concentration(50μg/mL)ozone macroautoblood therapy is more effective in the treatment of RA,which can re⁃duce the inflammatory response of patients,enhance immune function,further reduce the pain degree of patients,reduce disease activity,and improve the health status of patients.