甲氨蝶呤联合艾拉莫德治疗难治性类风湿关节炎的效果

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摘要 [摘要] 目的观察甲氨蝶呤（MTX）联合艾拉莫德治疗难治性类风湿关节炎的效果。方法 60例难治性类风湿关节炎患者均来自2013年12月～2014年2月南京医科大学附属淮安第一医院风湿免疫科，将其随机分为实验组和对照组，各30例。实验组给予艾拉莫德（50 mg/d）联合MTX（每周15 mg）治疗，对照组仅以相同方法予MTX治疗，疗程16周。治疗前、治疗后16周评估记录患者疾病活动性评分（DAS28），并采血以酶联免疫吸附测定法检测肿瘤坏死因子α（TNF-α）、血管内皮生长因子（VEGF）水平。结果两组治疗前DAS28评分比较差异无统计学意义[实验组：（5.97±1.62）分；对照组：（6.40±1.90）分；P ＞ 0.05]，两组治疗16周后DAS28评分[实验组：（3.02±1.24）分；对照组：（5.65±1.86）分]均较治疗前显著下降，差异均有统计学意义（P ＜ 0.01、P ＜ 0.05），且实验组治疗16周后DAS28评分较对照组下降更明显，差异有高度统计学意义（P ＜ 0.01）。两组治疗前血清TNF-α浓度比较差异无统计学意义[实验组：（379.27±114.70）pg/mL；对照组：（368.86±127.06）pg/mL；P ＞ 0.05]，两组治疗16周后血清TNF-α浓度[实验组：（230.42±67.23）pg/mL；对照组：（309.65±95.59）pg/mL]均较治疗前显著下降，差异均有统计学意义（P ＜ 0.01、P ＜ 0.05），且实验组TNF-α浓度下降更明显，与对照组比较差异有高度统计学意义（P ＜ 0.01）。两组治疗前血清VEGF浓度比较差异无统计学意义[实验组：（1124.11±305.06）pg/mL；对照组：（1142.02±174.02）pg/mL；P ＞ 0.05]，两组治疗16周后血清VEGF浓度[实验组：（818.89±178.78）pg/mL；对照组：（1000.21±245.87）pg/mL]均较治疗前显著下降，差异均有统计学意义（P ＜ 0.01、P ＜ 0.05），且实验组下降更显著，两组比较差异有高度统计学意义（P ＜ 0.01）。结论 MTX联合艾拉莫德对难治性类风湿关节炎患者具有较好的疗效，且安全性高。

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	孟德钎潘文友▲ 李鞠李慧李芳刘姗姗李永胜程玉玲

关键词 ： [关键词] 艾拉莫德, 甲氨蝶呤, 难治性类风湿关节炎, 肿瘤坏死因子-&alpha, 血管内皮生长因子

Abstract：[Abstract] Objective To observe the effect of Methotrexate (MTX) combined with Iguratimod in the treatment of patients with refractory rheumatoid arthritis. Methods Sixty patients with refractory rheumatoid arthritis were all coming from Department of Rheumatology, Huai'an First People's Hospital, Nanjing Medical University from December 2013 to February 2014, they were randomly divided into experimental group and control group, with 30 cases in each group. The experimental group was given Iguratimod (50 mg/d) and MTX (15 mg one week), the control group was given the same dose of MTX, the course was 16 weeks. Before treatment and after treatment for 16 weeks, the disease activity score 28 (DAS28) was evaluated and recorded. And serum samples were retrieved, levels of tumor necrosis factor alpha (TNF-α) and vascular endothelial growth factor (VEGF) were quantified by enzyme-linked immunosorbent assays. Results There was no statistically significant difference of DAS28 score before treatment between the two groups [experimental group: (5.97±1.62) points; control group: (6.40±1.90) points; P ＞ 0.05]. After treatment for 16 weeks, DAS28 score of the two groups decreased significantly than before treatment [experimental group: (3.02±1.24) points; control group: (5.65±1.86) points], the differences were all statistically significant (P ＜ 0.01, P ＜ 0.05), and DAS28 score of the experimental group was reduced more obviously than that of control group, the difference was highly statistically significant (P ＜ 0.01). There was no statistically significant difference of TNF-α before treatment between the two groups [experimental group: (379.27±114.70) pg/mL; control group: (368.86±127.06) pg/mL, P ＞ 0.05]. After treatment for 16 weeks, the levels of TNF-α of the two groups were significantly reduced compared with those before treatment [experimental group: (230.42±67.23) pg/mL; control group: (309.65±95.59) pg/mL], the differences were all statistically significant (P ＜ 0.01, P ＜ 0.05), and the level of TNF-α of the experimental group decreased more obviously than that of control group, the difference was highly statistically significant (P ＜ 0.01). There was no statistically significant difference of VEGF before treatment between the two groups [experimental group: (1124.11±305.06) pg/mL; control group: (1142.02±174.02) pg/mL; P ＞ 0.05]. After treatment for 16 weeks, the levels of VEGF of the two groups were significantly reduced compared with those before treatment [experimental group: (818.89±178.78) pg/mL; control group: (1000.21±245.87) pg/mL], the differences were all statistically significant (P ＜ 0.01, P ＜ 0.05), and the level of VEGF of the experimental group decreased more obviously than that of control group, the difference was highly statistically significant (P ＜ 0.01). Conclusion MTX combined with Iguratimod has a good efficacy for treatment of patients with refractory rheumatoid arthritis, with high safety.

Key words： [Key words] Iguratimod Methotrexate Refractory rheumatoid arthritis Tumor necrosis factor alpha Vascular endothelial growth factor

基金资助:[基金项目] 江苏省淮安市科技支撑（社会发展）计划项目（HAS2013011）。

通讯作者: ▲通讯作者

引用本文:

孟德钎潘文友▲ 李鞠李慧李芳刘姗姗李永胜程玉玲. 甲氨蝶呤联合艾拉莫德治疗难治性类风湿关节炎的效果[J]. 中国医药导报, 2016, 13(3): 137-141.
MENG Deqian PAN Wenyou▲ LI Ju LI Hui LI Fang LIU Shanshan LI Yongsheng CHENG Yuling. Effect of Methotrexate combined with Iguratimod in the treatment of patients with refractory rheumatoid arthritis. 中国医药导报, 2016, 13(3): 137-141.

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