摘要
目的观察羟氯喹对老年类风湿关节炎(RA)患者血栓形成因子及炎症细胞因子的影响。方法选取2016年1月至2017年3月西安市第五医院收治的96例老年RA患者,随机均分为2组,对照组给予来氟米特片口服,观察组在对照组用药基础上给予羟氯喹联合来氟米特片口服,检测2组治疗前后血栓形成因子[血小板聚集率(PAG)、D-二聚体(D-dimer)、红细胞沉降率(ESR)、纤维蛋白原(Fg)及血管性血友病因子(vWF)]、血管细胞黏附分子1(VCAM-1)、巨噬细胞移动抑制因子(MIF)、血清炎症细胞因子[白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、IL-1α]、RA疾病活动评分(DAS28)、肿胀与触痛关节数目及不良反应情况。采用t检验比较观察组与对照组上述指标的组间差异以及组内差异,采用χ2检验比较2组不良反应发生率的差异。结果经过3个月的治疗后,观察组的PAG、D-dimer、ESR、Fg、vWF、VCAM-1、MIF水平明显低于对照组[(48.25±5.95)%vs(67.83±5.36)%;(0.24±0.11)mg/L vs(0.31±0.13)mg/L;(19.83±11.13)mm/h vs (26.87±10.70)mm/h;(3.15±1.87)g/L vs (4.09±2.95)g/L,(23.87±6.04)μg/L vs(30.56±7.12)μg/L,(2.31±0.30)ng/L vs(2.64±0.38)ng/L、(36.01±16.57)ng/L vs (45.28±10.15)ng/L,差异有统计学意义(t=3.01、2.68、2.30、2.66、2.38、2.68和2.54,P均<0.05);血清IL-6、TNF-α、IL-1α水平亦明显低于对照组[(6.93±1.52)%vs(9.65±1.76)ng/L、(1.97±0.36)ng/L vs(2.51±0.36)ng/L、(0.11±0.02)ng/L vs (0.21±0.03)ng/L],差异有统计学意义(t=4.62、2.62、5.83,P均<0.05);观察组的DAS28评分明显低于对照组[(2.86±1.25)分vs (3.52±1.69)分],差异有统计学意义(t=2.64,P <0.05);2组的不良反应总发生率比较差异无统计学意义[18.75%vs 14.58%,χ2=0.30,P> 0.05]。结论在来氟米特治疗基础上予以羟氯喹,可有效缓解RA患者炎症,对血管内皮功能起到保护作用,抑制血栓形成,治疗效果显著且不良反应少。
ObjectiveTo observe the effect of hydroxychloroquine on thrombosis associated factors and infiammatory cytokines in elderly patients with rheumatoid arthritis （RA）. MethodsNinety-six elderly RA patients treated at our hospital from January 2016 to March 2017 were enrolled in the study and randomly divided into either a control group or an observation group, with 48 cases in each group. Both groups were given leflunomide, and the observation group was additionally given hydroxychloroquine. The levels of thrombosis associated factors [platelet aggregation rate （PAG）, D-dimer, erythrocyte sedimentation rate （ESR）, fibrinogen （Fg）, and von Willebrand factor （vWF）], vascular cell adhesion molecule 1 （VCAM-1）, macrophage migration inhibitory factor （MIF）, infiammatory cytokines in synovial fiuid [interleukin-6 （IL-6）, tumor necrosis factor α （TNF-α）, and interleukin-1α（IL-1α）], disease activity score （DAS28）, the number of swollen and tender joints, and adverse reactions were compared between the two groups before and after treatment. ResultsAfter 3 months of treatment, the levels of PAG, D-D, ESR, Fg, vWF, VCAM-1, and MIF in the observation group were significantly lower than those in the control group （P 〈0.05）, and the levels of IL-6, TNF-α, and IL-1 were also significantly lower than those in the control group （P 〈0.05）. The DAS28 score of the observation group was significantly lower than that of the control group （P 〈 0.05）, and the number of swollen and tender joints was significantly less than that of the control group （P 〈 0.05）. There was no significant difference in the total incidence of adverse reactions between the two groups （P 〉0.05）. ConclusionHydroxychloroquine plus lefiunomide treatment can effectively alleviate inflammation, protect vascular endothelial function, and inhibit thrombosis in elderly RA patients with few adverse reactions.
作者
刘丹
吕艳艳
刘焕
曹团平
王晓元
Liu Dan;Lyu Yanyan;Liu Huan;Cao Tuanping;Wang Xiaoyuan(Departement of Rheumatology and Immunology,Xi＇an No.5 Hospital,Xi′an 710082,China;Departement of Rheumatology and Immunology,LanZhou University Second Hospital,Lanzhou 730030,China)
出处
《中华临床医师杂志（电子版）》
CAS
2017年第24期2469-2474,共6页
Chinese Journal of Clinicians(Electronic Edition)
基金
陕西省社会发展公关项目(2017SF-245)
陕西省自然科学基金(2015JM8483
2016JM8147)
陕西省中医药管理局科研项目(15-JC025
Lcms057)
西安市科技计划项目[201805096YX4SF30(14)]
西安市中医药科研项目(2018年度)
兰州市科技计划项目(项目编号:2015-2-56)
关键词
羟氯喹
类风湿关节炎
血栓
炎症细胞因子
Hydroxychloroquine
Rheumatoid arthritis
Thrombosis
Inflammatory cytokines
