艾拉莫德联合依那西普治疗难治性类风湿性关节炎的临床疗效研究
|
摘要
目的观察艾拉莫德治疗难治性类风湿关节炎(RA)病人的近期临床疗效。方法按纳入标准,将2014年6月至2015年10月重庆三峡中心医院收治的60例难治性RA病人采用随机数字表法分为两组,其中艾拉莫德组使用艾拉莫德联合依那西普治疗,甲氨蝶呤组使用甲氨蝶呤联合依那西普治疗,记录两组病人治疗12周后的临床指标,包括DAS28评分、关节疼痛数、关节肿胀数、晨僵时间、类风湿因子、红细胞沉降率和C反应蛋白。结果艾拉莫德组总有效率为96.66%,甲氨蝶呤组为93.33%,艾拉莫德组疗效优于甲氨蝶呤组,差异有统计学意义(Uc=4.505,P=0.034)。艾拉莫德组与甲氨蝶呤组在治疗前的DAS28评分、关节疼痛数、关节肿胀数、晨僵时间、类风湿因子、红细胞沉降率和C反应蛋白数值比较差异无统计学意义(P>0.05)。经12周治疗后,两组DAS28评分、关节疼痛数、关节肿胀数、晨僵时间、类风湿因子、红细胞沉降率和C反应蛋白均较治疗前下降,差异有统计学意义(P<0.05);治疗后艾拉莫德组的DAS28评分、关节疼痛数、关节肿胀数、晨僵时间、类风湿因子、红细胞沉降率和C反应蛋白数值均低于甲氨蝶呤组,差异有统计学意义(P<0.05)。结论艾拉莫德联合依那西普对难治性RA病人具有确切的近期疗效,优于甲氨蝶呤联合依那西普治疗方案。
Objective To observe the effect of iguratimod combined with etanercept in treating patients with refractory rheumatoid arthritis(RA).Methods According to the inclusion criteria,60 patients with refractory rheumatoid arthritis treated in Chongqing Three Gorges Center Hospital from June 2014 to October 2015 were collected and randomly assigned into iguratimod group and methotrexate group by using the random number table method.The iguratimod group was treated with iguratimod combined with etanercept while the methotrexate group was treated with methotrexate combined with etanercept.After 12 weeks of treatment,the clinical indicators including DAS28 score,number of joint pain and joint swelling,morning stiffness time,rheumatoid factors(RF),erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were recorded and compared between the two groups.Results The total effective rate of iguratimod group was 96.66%,and that of the methotrexate group was 93.33%.The curative effect of the iguratimod group was better than that of the methotrexate group,with statistically significant difference(Uc=4.505,P=0.034).Before treatment,DAS28 score,number of joint pain and joint swelling,morning stiffness time,RF,ESR and CRP of the two groups had no statistically significant differences(P>0.05).After 12 weeks of treatment,DAS28 score,number of joint pain and joint swelling,morning stiffness time,RF,ESR and CRP of the two group were decreased with statistically significant difference(P<0.05).After treatment,DAS28 score,number of joint pain and joint swelling,morning stiffness time,RF,ESR and CRP of iguratimod group were lower than those in the methotrexate group;the differences were statistically significant(P<0.05).Conclusion Iguratimod combined with etanercept in treating patients with refractory rheumatoid arthritis had a definite short-term curative effect,and was superior to methotrexate combined with etanercept.
Objective To observe the effect of iguratimod combined with etanercept in treating patients with refractory rheumatoid arthritis(RA).Methods According to the inclusion criteria,60 patients with refractory rheumatoid arthritis treated in Chongqing Three Gorges Center Hospital from June 2014 to October 2015 were collected and randomly assigned into iguratimod group and methotrexate group by using the random number table method.The iguratimod group was treated with iguratimod combined with etanercept while the methotrexate group was treated with methotrexate combined with etanercept.After 12 weeks of treatment,the clinical indicators including DAS28 score,number of joint pain and joint swelling,morning stiffness time,rheumatoid factors(RF),erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were recorded and compared between the two groups.Results The total effective rate of iguratimod group was 96.66%,and that of the methotrexate group was 93.33%.The curative effect of the iguratimod group was better than that of the methotrexate group,with statistically significant difference(Uc=4.505,P=0.034).Before treatment,DAS28 score,number of joint pain and joint swelling,morning stiffness time,RF,ESR and CRP of the two groups had no statistically significant differences(P>0.05).After 12 weeks of treatment,DAS28 score,number of joint pain and joint swelling,morning stiffness time,RF,ESR and CRP of the two group were decreased with statistically significant difference(P<0.05).After treatment,DAS28 score,number of joint pain and joint swelling,morning stiffness time,RF,ESR and CRP of iguratimod group were lower than those in the methotrexate group;the differences were statistically significant(P<0.05).Conclusion Iguratimod combined with etanercept in treating patients with refractory rheumatoid arthritis had a definite short-term curative effect,and was superior to methotrexate combined with etanercept.
引文
[1]焦志军,王文红,李晶,等.类风湿关节炎患者外周血单个核细胞Notch及其配体表达[J].现代免疫学,2007,27(6):477-480.
[2]蔡辉,常文静,商玮.血管新生在类风湿关节炎中的作用[J].安徽医药,2015,19(3):417-421.
[3]范家德.白藜芦醇抗类风湿关节炎研究进展[J].安徽医药,2015,19(10):1845-1848.
[4]GENOVESE MC,BATHON JM,FLEISCHMANN RM,et al.Longterm safety,efficacy,and radiographic outcome with etanercept treatment in patients with early rheumatoid arthritis[J].J Rheumatol,2005,32(7):1232-1242.
[5]胡大伟,鲍春德,陈顺乐,等.重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗类风湿关节炎双盲随机多中心对照临床研究[J].中华风湿病学杂志,2005,9(11):664-668.
[6]EMERY P,BREEDVELD FC,HALL S,et al.Comparison of methotrexate monotherapy with a combination of methotrexate and etenercept in active,early,moderate to severe rheumatoid arthritis(COMET):arandomized,double-blind,parallel treatment trial[J].Lancet,2008,372(9636):375-382.
[7]舒强,李兴福,侯怀水,等.艾拉莫德对骨关节炎滑膜成纤维细胞特性的影响[J].中华风湿病学杂志,2006,10(7):389-392.
[8]张玉萍,姚茹冰,赵智明,等.IL-17在类风湿关节炎中的研究进展[J].安徽医药,2016,20(3):580-582.
[9]DU F,LYU LJ,FU Q,et al.T-614,a novel immunomodulator,attenuates joint inflammation and articular damage in collagen-induced arthritis[J].Arthritis Res Ther,2008,10(6):R136.
[10]TANAKA K,YAMAMOTO T,AIKAWA Y,et al.Inhibitory effects of an anti-rheumatic agent T-614 on immunoglobulin production by cultured B cells and rheumatoid synovial tissues engrafted into SCID mice[J].Rheumatology(Oxford),2003,42(11):1365-1371.
[11]谭源源.重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白联合甲氨蝶呤治疗对类风湿关节炎临床及炎性细胞因子的影响分析[J].临床医学,2016,36(2):38-40.
[12]张源潮,王峰,王威严,等.类风湿关节炎治疗新药艾拉莫德[J].世界临床药物,2013,34(2):65-69.
[13]陈艳霞,苏研,房向东,等.系统评价艾拉莫德治疗类风湿性关节炎的疗效与安全性[J].重庆医学,2015,44(18):2572-2574,2582.
[14]王晓元,沈海丽.艾拉莫德对类风湿关节炎滑膜细胞体外干预实验研究[J].陕西医学杂志,2015,44(3):292-293,302.
[2]蔡辉,常文静,商玮.血管新生在类风湿关节炎中的作用[J].安徽医药,2015,19(3):417-421.
[3]范家德.白藜芦醇抗类风湿关节炎研究进展[J].安徽医药,2015,19(10):1845-1848.
[4]GENOVESE MC,BATHON JM,FLEISCHMANN RM,et al.Longterm safety,efficacy,and radiographic outcome with etanercept treatment in patients with early rheumatoid arthritis[J].J Rheumatol,2005,32(7):1232-1242.
[5]胡大伟,鲍春德,陈顺乐,等.重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗类风湿关节炎双盲随机多中心对照临床研究[J].中华风湿病学杂志,2005,9(11):664-668.
[6]EMERY P,BREEDVELD FC,HALL S,et al.Comparison of methotrexate monotherapy with a combination of methotrexate and etenercept in active,early,moderate to severe rheumatoid arthritis(COMET):arandomized,double-blind,parallel treatment trial[J].Lancet,2008,372(9636):375-382.
[7]舒强,李兴福,侯怀水,等.艾拉莫德对骨关节炎滑膜成纤维细胞特性的影响[J].中华风湿病学杂志,2006,10(7):389-392.
[8]张玉萍,姚茹冰,赵智明,等.IL-17在类风湿关节炎中的研究进展[J].安徽医药,2016,20(3):580-582.
[9]DU F,LYU LJ,FU Q,et al.T-614,a novel immunomodulator,attenuates joint inflammation and articular damage in collagen-induced arthritis[J].Arthritis Res Ther,2008,10(6):R136.
[10]TANAKA K,YAMAMOTO T,AIKAWA Y,et al.Inhibitory effects of an anti-rheumatic agent T-614 on immunoglobulin production by cultured B cells and rheumatoid synovial tissues engrafted into SCID mice[J].Rheumatology(Oxford),2003,42(11):1365-1371.
[11]谭源源.重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白联合甲氨蝶呤治疗对类风湿关节炎临床及炎性细胞因子的影响分析[J].临床医学,2016,36(2):38-40.
[12]张源潮,王峰,王威严,等.类风湿关节炎治疗新药艾拉莫德[J].世界临床药物,2013,34(2):65-69.
[13]陈艳霞,苏研,房向东,等.系统评价艾拉莫德治疗类风湿性关节炎的疗效与安全性[J].重庆医学,2015,44(18):2572-2574,2582.
[14]王晓元,沈海丽.艾拉莫德对类风湿关节炎滑膜细胞体外干预实验研究[J].陕西医学杂志,2015,44(3):292-293,302.