摘要
目的探讨小剂量来氟米特配合甲氨蝶呤治疗老年首发类风湿关节炎(rheumatoid arthritis,RA)患者的效果。方法选取2020年2月至2023年2月西安市第五医院收治的120例老年首发RA患者进行随机对照试验。采用随机数字表法将其分为配合组及参考组,各60例。配合组男37例,女23例,年龄(70.22±5.29)岁,体质量指数(body mass index,BMI)(22.87±1.55)kg/m^(2),病程(4.76±0.85)年。参考组男38例,女22例,年龄(70.31±5.34)岁,BMI(22.94±1.58)kg/m^(2),病程(4.82±0.87)年。参考组采用甲氨蝶呤治疗,配合组则于参考组的基础上采用小剂量来氟米特治疗。两组均治疗90 d。对比两组临床疗效,临床症状改善情况,治疗前后骨代谢指标水平和血清壳多糖酶3样蛋白1(chitinase 3-like protein1,CHI3L1)、可溶性基质裂解素2(soluble suppression of tumorigenicity 2,sST2)、白细胞介素-32(interleukin-32,IL-32)水平,不良反应。采用χ^(2)检验和t检验。结果配合组总有效率高于参考组[96.67%(58/60)比83.33%(50/60)](χ^(2)=5.926,P=0.015)。配合组关节压痛数目、关节肿胀数目分别为(5.23±1.05)个、(4.18±0.66)个,均少于参考组的(7.45±1.36)个、(6.39±0.82)个,晨僵时长为(34.58±4.68)min,短于参考组的(50.40±8.21)min,双手握力为(14.03±2.55)kPa,高于参考组的(11.28±2.09)kPa(t=10.008、16.263、12.967、6.461,均P<0.001)。治疗后,配合组骨钙素(bone gla protein,BGP)、骨保护素(osteoprotectin,OPG)及总Ⅰ型胶原氨基端延长肽(total type I collagen amino terminal extension peptide,T-PⅠNP)水平分别为(27.48±5.02)ng/L、(5.02±0.74)ng/L、(43.17±8.59)μg/L,均高于参考组的(24.16±4.19)ng/L、(4.45±0.66)ng/L、(36.92±7.33)μg/L(t=3.933、4.453、4.287,均P<0.001)。治疗后,配合组血清CHI3L1、sST2、IL-32水平分别为(50.82±6.12)μg/L、(28.45±4.11)μg/L、(14.32±2.01)ng/L,均低于参考组的(78.45±8.39)μg/L、(33.05±5.24)μg/L、(16.85±2.77)ng/L(t=20.609、5.350、5.726,均P<0.001)。两组�
Objective To investigate the effect of low-dose leflumide combined with methotrexate for elderly patients with first-episode rheumatoid arthritis(RA).Methods One hundred and twenty elderly patients with first-episode RA admitted to Xi'an Fifth Hospital from February 2020 to February 2023 were selected for the randomized controlled trial.They were divided into a combination group and a reference group by the random number table method,with 60 cases in each group.There were 37 males and 23 females in the combination group;they were(70.22±5.29)years old;their body mass index(BMI)was(22.87±1.55)kg/m^(2);their disease course was(4.76±0.85)years.There were 38 males and 22 females in the reference group;they were(70.31±5.34)years old;their BMI was(22.94±1.58);their disease course was(4.82±0.87)years.The reference group were treated with methotrexate,and the combination group with low-dose leflunomide and methotrexate,for 90 d.The clinical efficacies,improvement of clinical symptoms,levels of bone metabolism indicators and serum levels of chitinase 3-like protein1(CHI3L1),soluble suppression of tumorigenicity 2(sST2),and interleukin-32(IL-32)before and after the treatment,and adverse reactions were compared between the two groups.χ^(2) and t tests were applied.Results The total effective rate of the combination group was higher than that of the reference group[96.67%(58/60)vs.83.33%(50/60);χ^(2)=5.926,P=0.015].The joint number with tenderness,joint number with swelling,duration of morning stiffness,and grip strength of both hands in the combination group were better than those in the control group[(5.23±1.05)vs.(7.45±1.36),(4.18±0.66)vs.(6.39±0.82),(34.58±4.68)min vs.(50.40±8.21)min,and(14.03±2.55)kPa vs.(11.28±2.09)kPa;t=10.008,16.263,12.967,and 6.461;P<0.001].After the treatment,the levels of bone gla protein(BGP),osteoprotectin(OPG),and total typeⅠcollagen amino terminal extension peptide(T-PⅠNP)in the combination group were higher than those in the reference group[(27.48±5.02)ng/L vs.(24.16±4.19
作者
盖楠楠
郭华
张洁
鲍蕴琦
Gai Nannan;Guo Hua;Zhang Jie;Bao Yunqi(Department of Rheumatology and Immunology,Xi'an Fifth Hospital,Xi'an 710082,China;Department of Orthopedics,Xi'an Central Hospital,Xi'an 710003,China)
出处
《国际医药卫生导报》
2024年第9期1498-1502,共5页
International Medicine and Health Guidance News
基金
陕西省重点研发计划(2019SF-177)
西安市科技计划(22YXYJ0004)。
