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目的观察艾拉莫德(IT)联合甲氨蝶呤(MTX)对难治性类风湿关节炎(rRA)的疗效,研究其对患者血管内皮生长因子(VEGF)、内皮抑素(ES)的影响。方法 60例rRA患者随机分为2组各30例,治疗组口服IT 50 mg·d-1,MTX 15 mg,每周1次,对照组仅口服MTX 15 mg,疗程16周。0,16周进行临床疾病活动性评分(DAS28),以酶联免疫吸附测定法检测血清VEGF、ES。结果治疗组16周后患者DAS28、VEGF,ES分别为(3.0±1.2)分,(818.9±178.8)pg·m L-1,(337.8±132.6)ng·m L-1,对照组分别为(5.7±1.9)分,(1 000.2±245.9)pg·m L-1,(253.8±77.8)ng·m L-1,治疗组DAS28、VEGF较0周均下降,差异均有统计学意义(P<0.01),治疗组较对照组下降更明显,差异有统计学意义(P<0.01);治疗组16周ES升高,与0周比较差异有统计学意义(P<0.01),治疗组与对照组比较差异有统计学意义(P<0.01)。结论 IT联合MTX对rRA疗效确切,安全性高,IT治疗RA可能与减少VEGF释放,增加ES的产生减轻滑膜血管新生有关。
Objective To observe the curative effect of iguratimod (MT) combined with methotrexate (MTX) on refractory rheumatoid arthritis (rRA) and its effect on the expression of vascular endothelial growth factor (VEGF), endostatin influences. Methods Sixty patients with rRA were randomly divided into two groups of 30 patients. The treatment group received oral IT 50 mg · d-1 and MTX 15 mg once a week. The control group only received MTX 15 mg orally for 16 weeks. The clinical disease activity score (DAS28) was measured at 0 and 16 weeks. Serum VEGF and ES were detected by enzyme linked immunosorbent assay. Results After treatment for 16 weeks, the DAS28, VEGF and ES were (3.0 ± 1.2) and (818.9 ± 178.8) pg · m L-1 and (337.8 ± 132.6) ng · m L-1, respectively 5.7 ± 1.9), (1 000.2 ± 245.9) pg · m L-1 and (253.8 ± 77.8) ng · m L-1, respectively. There were significant differences between the two groups (P <0.01), the treatment group decreased more significantly than the control group, the difference was statistically significant (P <0.01); treatment group 16 weeks ES increased, compared with 0 week was statistically significant (P <0.01) The difference between the control group was statistically significant (P <0.01). Conclusion IT combined with MTX is effective and effective in rRA. IT may be associated with the decrease of VEGF release and the increase of ES production in synovial angiogenesis.