摘要
目的观察依那西普联合来氟米特治疗老年类风湿关节炎的疗效及其对患者骨代谢指标、炎症因子及红细胞沉降率的影响。方法前瞻性选择2019年12月至2020年12月河北省沧州中西医结合医院收治的94例老年类风湿关节炎患者为研究对象,按照随机数字表法将其分为观察组和对照组,每组各47例。对照组给予来氟米特、扶他林口服治疗,来氟米特1次/d,2片/次,扶他林3次/d,1片/次;观察组在对照组基础上给予依那西普皮下注射,25 mg/次,2次/周,两组均治疗12周。比较两组临床疗效,治疗前、治疗12周后疾病活动指标[晨僵时间、关节触痛个数、关节肿胀个数、视觉模拟评分法(VAS)评分];检测骨代谢指标{血清25羟维生素D[25(OH)D]、Ⅰ型胶原羧基端肽交联(β-CTX)、骨钙素水平、炎症因子[肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]及红细胞沉降率;记录两组不良反应发生情况。结果两组治疗总有效率分别为80.85%、65.96%,比较差异无统计学意义(P>0.05)。治疗12周后,观察组的晨僵时间为(56.92±13.78)min,短于对照组[(72.06±22.64)min],观察组的关节触痛个数、关节肿胀个数分别为(6.39±2.07)、(1.95±0.47)个,少于对照组[(11.26±3.19)、(2.14±0.51)个],观察组的VAS评分为(2.74±0.71)分,低于对照组[(4.26±0.95)分],差异均有统计学意义(P<0.05)。治疗12周后,两组血清25(OH)D、骨钙素水平均较治疗前升高,血清β-CTX水平均较治疗前降低,观察组血清25(OH)D、骨钙素水平分别为(19.06±4.26)、(28.53±5.14)ng/mL,均高于对照组[(16.17±4.41)、(25.49±6.53)ng/mL],血清β-CTX水平为(0.42±0.14)ng/mL,低于对照组[(0.64±0.22)ng/mL],差异均有统计学意义(P<0.05)。治疗12周后,两组血清TNF-α、hs-CRP水平及红细胞沉降率均较治疗前降低,观察组血清TNF-α、hs-CRP水平及红细胞沉降率分别为(4.92±1.18)μg/L、(6.49±2.18)mg/L、(41.92±13.96)mm/h,均低于对照组[(7.44±1.54)μg/L、(8.63±2.56)mg/L、(61.77±19.82)mm/h],差异均有统计学意义(P<0.05)。两组不良反应发生率分别为14.89%、8.51%,比较差异无统计学意义(P>0.05)。结论依那西普联合来氟米特治疗老年类风湿关节炎有利于减轻晨僵、关节触痛、关节肿胀等症状,可改善骨代谢指标、减轻炎症反应、下调红细胞沉降率,安全性较好,具有推广价值。
Objective To observe the efficacy of etanercept combined with leflunomide in the treatment of elderly patients with rheumatoid arthritis and its effects on bone metabolism indexes,inflammatory factors and erythrocyte precipitation rate.Methods A total of 94 elderly patients with rheumatoid arthritis admitted to Hebei Cangzhou Hospital of Integrated Traditional and Western Medicine from December 2019 to December 2020 were prospectively selected and divided into observation group and control group by random number table method,with 47 cases in each group.The control group was given oral treatment with leflunomide and voltaline,leflunomide once a day,2 tablets each time,voltaline 3 times a day,1 tablet each time;the observation group was additionally given subcutaneous injection of Etanercept,25 mg each time,2 times a week,both groups were treated for 12 weeks.The clinical efficacy and disease activity indexes(morning stiffness time,number of joint tenderness,number of joint swelling,VAS),bone metabolism indexes[serum 25 hydroxyvitamin D[25(OH)D],βcross-linked C-telopeptide of type 1 collagen(β-CTX),osteocalcin]level,inflammatory factors[tumor necrosis fact-α(TNF-α),hypersensitive C-reactive protein(hs-CRP)]level and erythrocyte deposition rate before and after 12 weeks of treatment were compared between the two groups were detected.The occurrence of adverse reactions in the two groups was recorded.Results The total effective rate of the observation group and the control group was 80.85%and 65.96%,respectively,and there was no statistical significance between the two groups(P>0.05).After 12 weeks of treatment,the morning stiffness time of observation group was(56.92±13.78)min,which was shorter than that of the control group[(72.06±22.64)min],the number of joint tenderness and swelling in the observation group were 6.39±2.07 and 1.95±0.47,respectively,which were fewer than those of the control group(11.26±3.19)and(2.14±0.51),the VAS score of the observation group was(2.74±0.71)points,which was lower than that of the control group[(4.26±0.95)points],the differences were statistically significant(P<0.05).After 12 weeks of treatment,the levels of serum 25(OH)D and osteocalcin in the observation group were(19.06±4.26),(28.53±5.14)ng/mL,respectively,which were higher than those in control group[(16.17±4.41),(25.49±6.53)ng/mL],and the level of serumβ-CTX was(0.42±0.14)ng/mL,which was lower than that in the control group[(0.64±0.22)ng/mL],the differences were statistically significant(P<0.05).After 12 weeks of treatment,the levels of serum TNF-α,hs-CRP,and erythrocyte sedimentation rate in two groups were lower than those before treatment,and the levels of serum TNF-α,hs-CRP and erythrocyte sedimentation rate in the observation group were(4.92±1.18)μg/L,(6.49±2.18)mg/L and(41.92±13.96)mm/h,respectively,which were lower than those in the control group[(7.44±1.54)μg/L,(8.63±2.56)mg/L,(61.77±19.82)mm/h],the differences were statistically significant(P<0.05).The incidence of adverse reactions between the two groups was 14.89%and 8.51%,respectively,and there was no statistically significant difference between the two groups(P<0.05).Conclusion Etanercept combined with leflunomide in the treatment of elderly rheumatoid arthritis is beneficial to alleviate morning stiffness,joint tenderness,joint swelling and other symptoms,improve bone metabolism indexes,reduce inflammatory response,and reduce erythrocyte subsidence rate,with good safety and has the value of promotion.
作者
孙凤艳
冯红卫
刘振
齐欣欣
刘静
王晓磊
姜淑华
SUN Feng-yan;FENG Hong-wei;LIU Zhen(Department of Rheumatology,Hebei Cangzhou Hospital of Integrated Traditional and Western Medicine,Cangzhou Hebei 061001,China;Department of Osteology,Cangzhou People's Hospital,Cangzhou Hebei 061000,China)
出处
《临床和实验医学杂志》
2024年第2期165-169,共5页
Journal of Clinical and Experimental Medicine
基金
河北省医学科学研究课题项目(编号:20191284)。
关键词
类风湿关节炎
老年人
依那西普
来氟米特
骨代谢
炎症因子
红细胞沉降率
Rheumatoid arthritis
Aged
Etanercept
Leflunomide
Bone metabolism
Inflammatory factors
Erythrocyte sedimentation rate
