来氟米特和白芍总苷联合甲氨蝶呤治疗类风湿关节炎的疗效及安全性
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摘要
目的:观察探讨来氟米特和白芍总苷联合甲氨蝶呤治疗类风湿关节炎的治疗效果及安全性,总结临床用药经验。方法:选择2015年8月-2017年8月本院收治的80例类风湿关节炎患者,按照随机数字表法将其均分为两组,各40例,对照组采取常规来氟米特联合甲氨蝶呤治疗,观察组在其基础上加用白芍总苷治疗,治疗后观察对比两组临床疗效与治疗期间药物不良反应。结果:观察组患者在治疗后第36周的ACR20、ACR50、ACR70缓解率均显著高于对照组(P<0.05);两组患者治疗后第12、36周的晨僵时间、压痛指数、关节肿胀指数、DAS评分、CRP、RF、ESR、IL-1β、IL-6与治疗前相比,均有明显下降(P<0.05),而观察组下降程度更为显著(P<0.05);观察组不良反应发生率为15.0%,对照组为22.5%,两组比较差异无统计学意义(P>0.05)。结论:来氟米特和白芍总苷联合甲氨蝶呤治疗类风湿关节炎的近远期疗效明显,能调节免疫和改善炎性状态,值得临床合理推广使用。
Objective:To observe the therapeutic effect and safety of Leflunomide and Total Glucosides of Paeony combined with Methotrexate in the treatment of rheumatoid arthritis(RA),and summarizing the experience of clinical use.Method:A total of 80 patients with RA admitted in our hospital from August 2015 to August 2017 were divided into two groups according to the random number table group,40 cases in each group.The control group was treated with conventional Leflunomide combined with Methotrexate,while the observation group was treated with Total Glucosides of Paeony on the basis of the control group.After treatment,the effect and the adverse drug reaction of two groups were observed and compared.Result:The remission rates of ACR20,ACR50 and ACR70 in the thirty-sixth weeks after treatment in the observation group were significantly higher than those in the control group(P<0.05).After the twelfth,thirty-sixth weeks of treatment,the morning stiffness,pressure index,joint swelling index,DAS score,CRP,RF,ESR,IL-1βand IL-6 of two groups were significantly lower than those of before treatment(P<0.05),but the decline degree of the observation group was significantly lower than that in the observation group(P<0.05).The incidence of adverse reactions in the observation group was 15.0%,the control group was 22.5%,and the adverse reaction rates of two groups was not significantly different(P>0.05).Conclusion:The short-term and long-term effects of Leflunomide and Total Glucosides of Paeony combined with Methotrexate in the treatment of rheumatoid arthritis are obvious.It can regulate immunity and improve the inflammatory state.It is worth of popularizing in clinical practice.
Objective:To observe the therapeutic effect and safety of Leflunomide and Total Glucosides of Paeony combined with Methotrexate in the treatment of rheumatoid arthritis(RA),and summarizing the experience of clinical use.Method:A total of 80 patients with RA admitted in our hospital from August 2015 to August 2017 were divided into two groups according to the random number table group,40 cases in each group.The control group was treated with conventional Leflunomide combined with Methotrexate,while the observation group was treated with Total Glucosides of Paeony on the basis of the control group.After treatment,the effect and the adverse drug reaction of two groups were observed and compared.Result:The remission rates of ACR20,ACR50 and ACR70 in the thirty-sixth weeks after treatment in the observation group were significantly higher than those in the control group(P<0.05).After the twelfth,thirty-sixth weeks of treatment,the morning stiffness,pressure index,joint swelling index,DAS score,CRP,RF,ESR,IL-1βand IL-6 of two groups were significantly lower than those of before treatment(P<0.05),but the decline degree of the observation group was significantly lower than that in the observation group(P<0.05).The incidence of adverse reactions in the observation group was 15.0%,the control group was 22.5%,and the adverse reaction rates of two groups was not significantly different(P>0.05).Conclusion:The short-term and long-term effects of Leflunomide and Total Glucosides of Paeony combined with Methotrexate in the treatment of rheumatoid arthritis are obvious.It can regulate immunity and improve the inflammatory state.It is worth of popularizing in clinical practice.
引文
[1]董文红.白芍总苷联合来氟米特治疗老年类风湿关节炎临床观察[J].中医药临床杂志,2014,26(5):490-491.
[2]张勇.非甾体消炎药致老年人消化道出血回顾性分析[J].按摩与康复医学,2017,8(21):67-68.
[3]李陶冉,史丽璞,郇稳,等.甲氨蝶呤联合来氟米特治疗类风湿关节炎128例分析[J].北方药学,2017,14(1):51-53.
[4]麻璨琛.白芍总苷联合甲氨蝶呤治疗类风湿关节炎疗效的Meta分析[J].蚌埠医学院学报,2016,41(3):329-332.
[5]张斌,张珠凤,顾娟芳,等.临床缓解类风湿关节炎患者的超声评估[J].中华风湿病学杂志,2016,20(9):592-596.
[6]翁寿雍.痹痛灵对类风湿关节炎药效及免疫作用机制研究[D].南京:南京中医药大学,2016.
[7]余文景,许静,梁翼,等.白芍总苷胶囊联合甲氨蝶呤和来氟米特治疗类风湿关节炎的临床观察[J].四川医学,2018,39(1):83-85.
[8]黄玲玲.类风湿关节炎达标治疗与Cyr61、IL-6、IL-17等相关影响因素的临床研究[D].合肥:安徽医科大学,2016.
[9]韩玲,古洁乃特汗·拜克里木,巴燕·艾克海提,等.来氟米特联合白芍总苷治疗老年类风湿关节炎的疗效及对ESR、CRP、RF的影响研究[J].中国医院药学杂志,2016,36(7):568-571.
[10]Xiang N,Li X M,Zhang M J,et al.Total glucosides of paeony can reduce the hepatotoxicity caused by Methotrexate and Leflunomide combination treatment of active rheumatoid arthritis[J].International Immunopharmacology,2015,28(1):802-807.
[11]李志军,徐亮,李向培,等.白芍总苷对甲氨蝶呤联合来氟米特治疗类风湿关节炎所致肝功能异常的影响[J].中华风湿病学杂志,2013,17(3):169-172.
[12]史丽璞,和雅,郇稳,等.联合用药对类风湿关节炎促炎症细胞因子与急性相反应物的影响及疗效分析[J].实用医院临床杂志,2013,10(3):78-80.
[13]曲彩红,黎小妍,徐乐加,等.来氟米特与低剂量甲氨蝶呤联合塞来昔布致类风湿关节炎患者重度骨髓抑制伴肝肾功能损害[J].中国新药与临床杂志,2016,35(5):377-380.
[14]梁金梅.薏苡仁汤治疗类风湿关节炎的临床研究[D].武汉:湖北中医药大学,2012.
[15]赵侠,田图磊.白芍总苷对大鼠酒精性脂肪肝的保护作用及其机制[J].山东医药,2014,54(41):25-27.
[16]陈文莉,邹卫,徐力,等.白芍总苷对维持性腹膜透析患者微炎症状态的影响[J].临床肾脏病杂志,2016,16(3):148-151.
[17]王颖,苏娟.白细胞介素-31及其可溶性受体在类风湿关节炎患者血清中的表达[J].实用医学杂志,2017,33(20):3402-3405.
[18]耿学丽,陈向华,丁萌,等.类风湿关节炎患者血清白细胞介素的检测及意义[J].检验医学与临床,2015,12(7):912-914.
[19]周俊飞.血清KL-6及ACPA与类风湿关节炎合并间质性肺疾病病变程度的相关性研究[D].郑州:郑州大学,2016.
[20]周玲玲,魏伟,柳璋璞,等.白芍总苷对共培养诱生的破骨细胞的作用及机制[J].中国药理学通报,2014,30(11):1547-1551.
[2]张勇.非甾体消炎药致老年人消化道出血回顾性分析[J].按摩与康复医学,2017,8(21):67-68.
[3]李陶冉,史丽璞,郇稳,等.甲氨蝶呤联合来氟米特治疗类风湿关节炎128例分析[J].北方药学,2017,14(1):51-53.
[4]麻璨琛.白芍总苷联合甲氨蝶呤治疗类风湿关节炎疗效的Meta分析[J].蚌埠医学院学报,2016,41(3):329-332.
[5]张斌,张珠凤,顾娟芳,等.临床缓解类风湿关节炎患者的超声评估[J].中华风湿病学杂志,2016,20(9):592-596.
[6]翁寿雍.痹痛灵对类风湿关节炎药效及免疫作用机制研究[D].南京:南京中医药大学,2016.
[7]余文景,许静,梁翼,等.白芍总苷胶囊联合甲氨蝶呤和来氟米特治疗类风湿关节炎的临床观察[J].四川医学,2018,39(1):83-85.
[8]黄玲玲.类风湿关节炎达标治疗与Cyr61、IL-6、IL-17等相关影响因素的临床研究[D].合肥:安徽医科大学,2016.
[9]韩玲,古洁乃特汗·拜克里木,巴燕·艾克海提,等.来氟米特联合白芍总苷治疗老年类风湿关节炎的疗效及对ESR、CRP、RF的影响研究[J].中国医院药学杂志,2016,36(7):568-571.
[10]Xiang N,Li X M,Zhang M J,et al.Total glucosides of paeony can reduce the hepatotoxicity caused by Methotrexate and Leflunomide combination treatment of active rheumatoid arthritis[J].International Immunopharmacology,2015,28(1):802-807.
[11]李志军,徐亮,李向培,等.白芍总苷对甲氨蝶呤联合来氟米特治疗类风湿关节炎所致肝功能异常的影响[J].中华风湿病学杂志,2013,17(3):169-172.
[12]史丽璞,和雅,郇稳,等.联合用药对类风湿关节炎促炎症细胞因子与急性相反应物的影响及疗效分析[J].实用医院临床杂志,2013,10(3):78-80.
[13]曲彩红,黎小妍,徐乐加,等.来氟米特与低剂量甲氨蝶呤联合塞来昔布致类风湿关节炎患者重度骨髓抑制伴肝肾功能损害[J].中国新药与临床杂志,2016,35(5):377-380.
[14]梁金梅.薏苡仁汤治疗类风湿关节炎的临床研究[D].武汉:湖北中医药大学,2012.
[15]赵侠,田图磊.白芍总苷对大鼠酒精性脂肪肝的保护作用及其机制[J].山东医药,2014,54(41):25-27.
[16]陈文莉,邹卫,徐力,等.白芍总苷对维持性腹膜透析患者微炎症状态的影响[J].临床肾脏病杂志,2016,16(3):148-151.
[17]王颖,苏娟.白细胞介素-31及其可溶性受体在类风湿关节炎患者血清中的表达[J].实用医学杂志,2017,33(20):3402-3405.
[18]耿学丽,陈向华,丁萌,等.类风湿关节炎患者血清白细胞介素的检测及意义[J].检验医学与临床,2015,12(7):912-914.
[19]周俊飞.血清KL-6及ACPA与类风湿关节炎合并间质性肺疾病病变程度的相关性研究[D].郑州:郑州大学,2016.
[20]周玲玲,魏伟,柳璋璞,等.白芍总苷对共培养诱生的破骨细胞的作用及机制[J].中国药理学通报,2014,30(11):1547-1551.