风湿清合剂联合甲氨蝶呤治疗活动期类风湿关节炎疗效观察及作用机制探讨
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摘要
目的观察风湿清合剂联合甲氨蝶呤治疗活动期类风湿关节炎(RA)临床疗效,并探讨其作用机制。方法选取我院2016年2月—2017年8月收治的活动期RA患者82例,按治疗方式分为对照组和观察组,每组41例。对照组给予甲氨蝶呤,观察组在对照组基础上联合风湿清合剂,2组均治疗3个月。测定2组临床症状、疗效和不良反应情况,比较2组治疗前后血清中破骨细胞分化因子(RNAKL)、巨噬细胞炎性蛋白1α(MIP-1α)及白细胞介素-17(IL-17)水平。结果 2组治疗第6、12周晨僵时间、关节压痛指数及步行20米时间均优于治疗前,第6周优于第12周(P <0. 05),且观察组上述指标优于对照组(P <0. 05)。2组治疗第12周RNAKL和MIP-1α、IL-17水平均较治疗前降低,且观察组血清RNAKL和血清MIP-1α、IL-17水平均低于对照组(P <0. 05)。观察组治疗总有效率高于对照组(P <0. 05)。2组不良反应发生率比较差异无统计学意义(P> 0. 05)。结论风湿清合剂联合甲氨蝶呤治疗活动期RA比单纯西药治疗效果更好,可有效改善患者的症状且不良反应少,其作用机制可能是抑制血清中RNAKL水平和MIP-1α、IL-17等炎性因子水平,从而达到保护骨组织的效果。
Objective To investigate curative effect and mechanism of Fengshiqing mixture combined with Methotrexate in treatment of patients with rheumatoid arthritis during active stage. Methods A total of 82 patients with rheumatoid arthritis during active stage admitted during February 2016 and August 2017 were divided into control group( n =41) and observation group( n = 41) according to different treatment methods. Control group was treated with oral Methotrexate,while observation group was added with Fengshiqing mixture on the basis of treatment for control group,and both groups were treated for 3 month. In two groups,curative effect,symptoms and incidence rate of adverse reactions were compared,and levels of serum receptor activator of nuclear factor-kappa B ligand( RNAKL),macrophage inflammatory protein-1α( MIP-1α) and interleukin-17( IL-17) were detected before and after treatment. Results Values of morning stiffness time,joint tenderness index and walking time for 20 meters in the 6thand 12 thweeks of treatment were better than those before treatment in two groups,and thsoe in the 12 th were better than those in the 6thweek( P < 0. 05) and the values in observation group were significantly less than those in control group( P < 0. 05). Levels of RNAKL,MIP-1 and IL-17 in the 12 thweek of treatment were significantly lower than those before treatment in two groups,and the levels in observation group were significantly lower than those in control group( P < 0. 05). The total effective rate in observation group was significantly higher than that in control group( P < 0. 05),but there was no significant difference in incidence rate of adverse reactions between two groups( P > 0. 05). Conclusion Fengshiqing mixture combined with Methotrexate in the treatment of patients with rheumatoid arthritis during active stage is more effective than that by western medicine alone,and it may effectively improve symptoms and reduce incidence rate of adverse reactions. The mechanism may be to inhibit serum levels of inflammatory factors such as RNAKL,MIP-1α and IL-17 so as to protect bone tissues.
Objective To investigate curative effect and mechanism of Fengshiqing mixture combined with Methotrexate in treatment of patients with rheumatoid arthritis during active stage. Methods A total of 82 patients with rheumatoid arthritis during active stage admitted during February 2016 and August 2017 were divided into control group( n =41) and observation group( n = 41) according to different treatment methods. Control group was treated with oral Methotrexate,while observation group was added with Fengshiqing mixture on the basis of treatment for control group,and both groups were treated for 3 month. In two groups,curative effect,symptoms and incidence rate of adverse reactions were compared,and levels of serum receptor activator of nuclear factor-kappa B ligand( RNAKL),macrophage inflammatory protein-1α( MIP-1α) and interleukin-17( IL-17) were detected before and after treatment. Results Values of morning stiffness time,joint tenderness index and walking time for 20 meters in the 6thand 12 thweeks of treatment were better than those before treatment in two groups,and thsoe in the 12 th were better than those in the 6thweek( P < 0. 05) and the values in observation group were significantly less than those in control group( P < 0. 05). Levels of RNAKL,MIP-1 and IL-17 in the 12 thweek of treatment were significantly lower than those before treatment in two groups,and the levels in observation group were significantly lower than those in control group( P < 0. 05). The total effective rate in observation group was significantly higher than that in control group( P < 0. 05),but there was no significant difference in incidence rate of adverse reactions between two groups( P > 0. 05). Conclusion Fengshiqing mixture combined with Methotrexate in the treatment of patients with rheumatoid arthritis during active stage is more effective than that by western medicine alone,and it may effectively improve symptoms and reduce incidence rate of adverse reactions. The mechanism may be to inhibit serum levels of inflammatory factors such as RNAKL,MIP-1α and IL-17 so as to protect bone tissues.
引文
[1]王淼,代建宇.益赛普联合甲氨蝶呤治疗类风湿关节炎患者效果评价及对血清生化指标的影响[J].中国临床医生杂志,2017,45(6):74-76.
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[10]李育林,赵恒立,司文涛,等.五藤冲剂联合甲氨蝶呤治疗类风湿关节炎的临床研究[J].中国现代应用药学,2016,33(12):1570-1573.
[11]朱帅,黄煜鹏,贺勇,等.依那西普联合甲氨蝶呤治疗类风湿关节炎的临床观察[J].中国药物警戒,2016,13(5):266-268.
[12]毕丹艳,李芹,张虹,等.雷公藤多苷联合甲氨蝶呤治疗类风湿关节炎的临床疗效研究[J].中国临床药理学杂志,2016,32(10):880-882.
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[15]王莎莎,吴斌,邵勤,等.艾拉莫德阶段性联合甲泼尼龙和甲氨蝶呤治疗类风湿关节炎伴白细胞减少的临床观察[J].新医学,2017,48(2):114-117.
[16]文军,荣晓凤,徐艳明,等.电针治疗联合甲氨蝶呤对类风湿关节炎大鼠JAK-STAT信号通路及VEGF表达的影响[J].免疫学杂志,2018,24(3):239-246.
[17]黄艳艳,林书典,詹锋.中医辨证论治联合甲氨蝶呤治疗类风湿关节炎的近远期疗效研究[J].中国地方病防治杂志,2017,35(5):580.
[18]李东凌.培本治痹汤联合甲氨蝶呤治疗类风湿性关节炎的疗效及作用机制分析[J].四川中医,2017,16(7):146-148.
[19]赵辉,吕有强.三土汤联合西药治疗活动期类风湿关节炎60例[J].西部中医药,2016,29(12):93-95.
[20]霍爱鑫,高鹏,刘宇宏,等.依那西普联合甲氨蝶呤治疗类风湿关节炎的临床效果[J].延安大学学报:医学科学版,2017,15(1):20-23.
[21]毕东敏,李秀芝,魏剑芬,等.麝香乌龙丸联合甲氨蝶呤治疗活动期类风湿关节炎的临床观察[J].中国中医急症,2016,25(10):1937-1939.
[22]葛林,石志敏.当归拈痛汤加减联合甲氨蝶呤治疗类风湿关节炎的随机对照研究[J].中医药学报,2017,45(2):84-86.
[23]杨甜甜,王振宇.乌梅透骨汤联合甲氨蝶呤治疗类风湿关节炎疗效观察[J].现代中西医结合杂志,2018,28(7):716-718.
[24]姜淑华,武晔,胡丽伟,等.银苓消肿丸联合来氟米特与甲氨蝶呤治疗类风湿关节炎的临床疗效观察[J].西部医学,2016,28(11):1562-1565.
[2]牛红青,贾瑞环,赵文鹏,等.甲氨蝶呤周期联合小剂量环磷酰胺治疗类风湿关节炎的疗效及安全性评估[J].中国药物与临床,2016,16(5):617-621.
[3]范波,孙卫东.类风湿关节炎治疗中甲氨蝶呤及来氟米特联合应用的临床效果观察[J].重庆医学,2017,22(3):173-175.
[4]孟德钎,潘文友,李鞠,等.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.
[5]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.
[6]杨通宇,胡鲲,刘照时,等.飞金止痛胶囊联合甲氨蝶呤和雷公藤多苷治疗类风湿关节炎的临床观察[J].中国药房,2016,27(23):3218-3220.
[7]陈赵玲,刘岐焕,刘婧依,等.白芍总苷联合甲氨蝶呤治疗难治性类风湿关节炎效果观察[J].中华实用诊断与治疗杂志,2017,31(7):700-702.
[8]黄源.益赛普联合甲氨蝶呤治疗中重度活动性类风湿关节炎的疗效和安全性评价[J].医学临床研究,2017,34(8):1480-1482.
[9]罗东萍,刘秀梅,傅自力,等.他克莫司联合甲氨蝶呤治疗难治性类风湿关节炎临床分析[J].中华风湿病学杂志,2017,21(3):185-187.
[10]李育林,赵恒立,司文涛,等.五藤冲剂联合甲氨蝶呤治疗类风湿关节炎的临床研究[J].中国现代应用药学,2016,33(12):1570-1573.
[11]朱帅,黄煜鹏,贺勇,等.依那西普联合甲氨蝶呤治疗类风湿关节炎的临床观察[J].中国药物警戒,2016,13(5):266-268.
[12]毕丹艳,李芹,张虹,等.雷公藤多苷联合甲氨蝶呤治疗类风湿关节炎的临床疗效研究[J].中国临床药理学杂志,2016,32(10):880-882.
[13]房显辉,杨少峰,聂晓莉,等.小乌桂汤联合甲氨蝶呤治疗类风湿关节炎临床研究[J].中医学报,2016,31(4):603-605.
[14]胡放.中医辨证论治联合甲氨蝶呤治疗类风湿关节炎的近远期疗效研究[J].四川中医,2018,8(2):76-79.
[15]王莎莎,吴斌,邵勤,等.艾拉莫德阶段性联合甲泼尼龙和甲氨蝶呤治疗类风湿关节炎伴白细胞减少的临床观察[J].新医学,2017,48(2):114-117.
[16]文军,荣晓凤,徐艳明,等.电针治疗联合甲氨蝶呤对类风湿关节炎大鼠JAK-STAT信号通路及VEGF表达的影响[J].免疫学杂志,2018,24(3):239-246.
[17]黄艳艳,林书典,詹锋.中医辨证论治联合甲氨蝶呤治疗类风湿关节炎的近远期疗效研究[J].中国地方病防治杂志,2017,35(5):580.
[18]李东凌.培本治痹汤联合甲氨蝶呤治疗类风湿性关节炎的疗效及作用机制分析[J].四川中医,2017,16(7):146-148.
[19]赵辉,吕有强.三土汤联合西药治疗活动期类风湿关节炎60例[J].西部中医药,2016,29(12):93-95.
[20]霍爱鑫,高鹏,刘宇宏,等.依那西普联合甲氨蝶呤治疗类风湿关节炎的临床效果[J].延安大学学报:医学科学版,2017,15(1):20-23.
[21]毕东敏,李秀芝,魏剑芬,等.麝香乌龙丸联合甲氨蝶呤治疗活动期类风湿关节炎的临床观察[J].中国中医急症,2016,25(10):1937-1939.
[22]葛林,石志敏.当归拈痛汤加减联合甲氨蝶呤治疗类风湿关节炎的随机对照研究[J].中医药学报,2017,45(2):84-86.
[23]杨甜甜,王振宇.乌梅透骨汤联合甲氨蝶呤治疗类风湿关节炎疗效观察[J].现代中西医结合杂志,2018,28(7):716-718.
[24]姜淑华,武晔,胡丽伟,等.银苓消肿丸联合来氟米特与甲氨蝶呤治疗类风湿关节炎的临床疗效观察[J].西部医学,2016,28(11):1562-1565.