艾拉莫德联合甲氨蝶呤对类风湿性关节炎患者血清M-CSF、IL-6、IL-8及骨代谢的影响

目的：观察艾拉莫德联合甲氨蝶呤对类风湿性关节炎(RA)患者血清巨噬细胞集落刺激因子（M-CSF）、白介素-6(IL-6)、白介素-8(IL-8)及骨代谢的影响。方法选取我院风湿免疫科2013年6月至2015年6月收治的116例RA患者，按随机数字表法分为观察组和对照组，每组58例。对照组给予甲氨蝶呤片治疗，观察组在对照组治疗的基础上联合艾拉莫德治疗，持续治疗24周。比较治疗前后两组患者血清中M-CSF、IL-6和IL-8水平变化和骨代谢相关指标。结果治疗后观察组患者血清中环氧合酶(COX-2)、肿瘤坏死因子(TNF-α)、M-CSF、IL-6和IL-8各指标水平[(12.61±2.49) pg/mL、(5.48±1.36) pg/mL、(894±156) pg/mL、(2.49±0.46) pg/mL、(82.47±16.26) ng/mL]明显低于对照组[(16.88±3.94) pg/mL、(7.46±1.46) pg/mL、(1249±246) pg/mL、(4.76±1.21) pg/mL、(112.36±24.67) ng/mL]，差异均具有统计学意义(P<0.05)；治疗后观察组患者的N-端骨钙素(N-MID)、总1型胶原氨基端延长肽(T-P1NP)和25羟维生素D[25(OH)D]各指标含量[(19.34±3.98) ng/mL、(44.25±8.54) ng/mL、(18.72±3.86) ng/mL]明显高于对照组[(14.16±3.04) ng/mL、(32.47±7.42) ng/mL、(15.01±2.19) ng/mL]，差异均具有统计学意义(P<0.05)，而观察组β-胶原降解产物(β-CTX)、血沉、C-反应蛋白、触痛关节数及肿胀关节数和ADS28评分等指标[(0.47±0.11) pg/mL、(21.45±6.14) mm/h、(12.69±4.18) mg/L、(2.48±0.36)个、(1.24±0.26)个、(3.45±0.86)分]均明显低于对照组[(0.76±0.18) pg/mL、(36.42±9.17) mm/h、(19.38±5.12) mg/L、(3.89±0.76)个、(2.06±0.66)个、(5.85±1.69)分]，差异均具有统计学意义(P<0.05)。结论艾拉莫德联合甲氨蝶呤治疗类风湿性关节炎患者疗效显著，其能缓解关节疼痛及临床症状，改善患者骨代谢，值得临床推广应用。

Effects of iguratimod combined with methotrexate on serum M-CSF,IL-6, IL-8 and bone metabolism in patients with rheumatoid arthritis

Objective To observe the effects of iguratimod combined with methotrexate on serum macro-phage colony stimulating factor (M-CSF), interleukin-6 (IL-6), Interleukin-8 (IL-8) and bone metabolism in patients with rheumatoid arthritis (RA). Methods A total of 116 RA patients in our hospital from June 2013 to June 2015 were divided into the observation group and the control group according to random number table method, with 58 patients in each group. The control group was given methotrexate tablets, and the observation group received iguratimod treatment on the basis of the control group, continuously for 24 weeks. Changes of M-CSF, IL-6 and IL-8 levels in serum and re-lated indexes of bone metabolism of two groups before and after treatment were compared. Results Cyclooxygen-ase-2 (COX-2), tumor necrosis factor-α(TNF-α), M-CSF, IL-6 and IL-8 levels in serum in the observation group after treatment were (12.61±2.49) pg/mL, (5.48±1.36) pg/mL, (894±156) pg/mL, (2.49±0.46) pg/mL, (82.47±16.26) ng/mL re-spectively, which were significantly lower than those in the control group of (16.88 ± 3.94) pg/mL, (7.46 ± 1.46) pg/mL, (1249±246) pg/mL, (4.76±1.21) pg/mL, (112.36±24.67) ng/mL, P<0.05. N-MID, total procollagen type 1 amino-terminal propeptide (T-P1NP) and 25(OH)D content in the observation group after the treatment were (19.34±3.98) ng/mL, (44.25± 8.54) ng/mL, (18.72±3.86) ng/mL respectively, which were significantly higher than those in the control group of (14.16± 3.04) ng/mL, (32.47 ± 7.42) ng/mL, (15.01 ± 2.19) ng/mL, P<0.05.β-CTX, erythrocyte sedimentation rate, C-reactive pro-tein, tender joint number, swollen joint number and ADS28 scores were significantly lower than those in the control group, (0.47±0.11) pg/mL, (21.45±6.14) mm/h, (12.69±4.18) mg/L, (2.48±0.36), (1.24±0.26), (3.45±0.86) vs (0.76±0.18) pg/mL, (36.42±9.17) mm/h, (19.38±5.12) mg/L, (3.89±0.76), (2.06±0.66), (5.85±1.69), P<0.05. Conclusion Effect of igurati-mod combined with methotrexate in the treatment of rheumatoid arthritis patients is significant. It can relieve joint pain and clinical symptoms, improve bone metabolism of patients, and is worthy of clinical use.