摘要
目的探讨托珠单抗联合泼尼松、甲氨蝶呤治疗难治性中重度类风湿关节炎(RA)的临床疗效。方法选取医院2020年3月至2022年3月收治的难治性中重度RA患者145例,采用分层随机法分为观察组(72例)和对照组(73例)。两组患者均口服醋酸泼尼松片、甲氨蝶呤片,观察组患者加用托珠单抗注射液静脉滴注。两组均连续治疗3个月。结果治疗后,两组患者的关节疼痛评分、肿胀评分均显著降低,晨僵持续时间均显著缩短,疾病活动指数28量表评分均显著降低,Fugl-Meyer运动功能评价量表评分均显著升高,类风湿因子、C反应蛋白水平及红细胞沉降率均显著降低,基质金属蛋白酶-3水平均显著降低,金属蛋白酶组织抑制因子-1水平均显著升高(P<0.05);且观察组患者上述指标改善程度均更显著(P<0.05)。观察组与对照组不良反应发生率相当(11.11%比8.22%,P>0.05)。结论托珠单抗联合泼尼松、甲氨蝶呤治疗难治性中重度RA,可有效缓解患者的关节炎性症状,降低血清炎性指标水平,改善关节活动能力和关节损伤。
Objective To investigate the clinical efficacy of tocilizumab combined with prednisone and methotrexate in the treatment of refractory moderate-to-severe rheumatoid arthritis(RA).Methods A total of 145 patients with refractory moderate-to-severe RA admitted to the hospital from March 2020 to March 2022 were selected and divided into the observation group(72 cases)and the control group(73 cases)by the stratified random method.The patients in the two groups were given Prednisone Acetate Tablets and Methotrexate Tablets orally,on this basis,the patients in the observation group were given the intravenous drip with Tocilizumab Injection.Both groups were treated continuously for three months.Results After treatment,the joint pain score and swelling score in the two groups significantly decreased,the duration of morning stiffness significantly shortened,the 28-joint Disease Activity Score(DAS-28)score significantly decreased,the Fugl-Meyer Motor Assessment(FMA)score significantly increased,the rheumatoid factor(RF),C-reactive protein(CRP)levels and erythrocyte sedimentation rate(ESR)significantly decreased,the matrix metalloproteinase-3(MMP-3)level significantly decreased,and the tissue inhibitor of metalloproteinase-1(TIMP-1)level significantly increased(P<0.05).Moreover,the above indexes improved more significantly in the observation group(P<0.05).The incidence of adverse reactions in the observation group was similar to that in the control group(11.11%vs.8.22%,P>0.05).Conclusion Tocilizumab combined with prednisone and methotrexate in the treatment of refractory moderate-to-severe RA can effectively relieve the symptoms of joint inflammation,decrease the serum inflammatory index levels,improve joint activity ability and joint injuries.
作者
李杰
邓泽辉
王英
张剑
LI Jie;DENG Zehui;WANG Ying;ZHANG Jian(West China Hospital,Sichuan University,Chengdu,Sichuan,China 610044)
出处
《中国药业》
CAS
2024年第4期97-100,共4页
China Pharmaceuticals
基金
四川省科技计划项目[2023JDR0251]。
关键词
托珠单抗
泼尼松
甲氨蝶呤
难治性
类风湿关节炎
中重度
炎性指标
tocilizumab
prednisone
methotrexate
refractory
rheumatoid arthritis
moderate-to-severe
inflammatory index
