羟氯喹联合甲氨蝶呤治疗老年类风湿关节炎的疗效及对血脂的影响

Efficacy of hydroxychloroquine combined with methotrexate in the treatment of elderly rheumatoid arthritis and its influence on blood lipid

目的观察羟氯喹联合甲氨蝶呤治疗老年类风湿关节炎(RA)的疗效及对血脂的影响。方法选取2019年1月—2023年1月中国人民解放军陆军第七十三集团军医院(厦门大学附属成功医院)收治的老年RA患者102例,依据随机数字表法分为羟氯喹联合组和单用甲氨蝶呤组,每组51例。羟氯喹联合组给予羟氯喹联合甲氨蝶呤治疗,单用甲氨蝶呤组给予甲氨蝶呤治疗,2组均治疗6个月。比较2组临床疗效,血脂指标[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白-A1(Apo-A1)、载脂蛋白-B100(Apo-B100)]、血清环氧合酶-2(COX-2)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、总Ⅰ型胶原氨基端延长肽(TPⅠNP)、骨钙素N端中分子(N-MID)水平。结果羟氯喹联合组总有效率高于单用甲氨蝶呤组(98.04%vs.84.31%,χ^(2)=4.387,P=0.036)。治疗6个月后,2组DAS28评分均低于治疗前,且羟氯喹联合组低于单用甲氨蝶呤组(P<0.01);2组TC、TG、LDL-C、Apo-B100、COX-2、TNF-α及IL-6水平均低于治疗前,Apo-A1、TPⅠNP及N-MID水平均高于治疗前,且羟氯喹联合组低/高于单用甲氨蝶呤组(P<0.05或P<0.01)。结论羟氯喹联合甲氨蝶呤治疗老年RA的临床效果较好,可调节患者细胞因子、骨代谢及血脂,促进病情转归。

Objective To observe the efficacy of hydroxychloroquine combined with methotrexate in the treatment of elderly rheumatoid arthritis(RA)and its influence on blood lipid.Methods A total of 102 elderly RA patients admitted to the 73rd Group Army Hospital of the People′s Liberation Army of China(Xiamen University Affiliated Success Hospital)from January 2019 to January 2023 were selected and divided into hydroxychloroquine combined group and methotrexate alone group according to random number table method,with 51 cases in each group.Hydroxychloroquine combined group was treated with hydroxychloroquine combined with methotrexate,and methotrexate alone group was treated with methotrexate.Both groups were treated for 6 months.The clinical efficacy of the two groups were compared,and the levels of lipid index(TC,TG,LDL-C,Apo-A1,Apo-B100),COX-2,TNF-α,IL-6,TPⅠNP and N-MID were compared.Results The total effective rate of hydroxychloroquine combined group was higher than that of methotrexate alone group(98.04%vs.84.31%,χ^(2)=4.387,P=0.036).After 6 months of treatment,DAS28 scores in 2 groups were lower than before treatment,and hydroxychloroquine combined group was lower than methotrexate alone group(P<0.01).TC,TG,LDL-C,Apo-B100,COX-2,TNF-αand IL-6 levels in 2 groups were lower than before treatment,Apo-A1,TPⅠNP and N-MID levels were higher than before treatment,hydroxychloroquine combination group was lower/higher than methotrexate alone group(P<0.05 or P<0.01).Conclusion Hydroxychloroquine combined with methotrexate has good clinical effect in the treatment of elderly RA,which can regulate the cytokines,bone metabolism and blood lipids of patients,and promote the outcome of the disease.