艾拉莫德联合甲氨蝶呤对难治性类风湿关节炎患者血管新生相关细胞因子的影响

摘要

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 10~15 mg，每周1次，对照组仅口服MTX 10~15 mg，疗程16周。0，16周进行临床评估，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•mL－1，(337.8±132.6) ng•mL－1，对照组分别为(5.7±1.9)分，(1000.2±245.9) pg•mL－1，(253.8±77.8) ng•mL－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 effects of iguratimod ( IT) combined with methotrexate ( MTX) in patients with refractory rheumatoid arthritis ( rRA) . Methods Sixty patients with rRA were randomly divided into 2 groups ( n=30 each group) . The cases in treatment group received 50 mg.d-1 of iguratimod and 10 mg of MTX for 16 weeks. The cases in control group were treated by 10-15 mg of MTX. DAS28 was analyzed. Levels of VEGF and endostatin ( ES) were quantified. Results In the treatment group,after 16-week treatment,DAS28,levels of VEGF and ES were (3.0±1.2),(818.9±178.8) pg.mL-1, (337.8±132.6) ng.mL-1,and those in the control group were (5.7±1.9),(1000.2±245.9) pg.mL-1,(253.8±77.8) ng.mL-1,respectively. In the treatment group,DAS28 and VEGF after the treatment were significantly decreased as compared with those before the treatment ( P<0.01) . The decrement was more significant in the treatment group than in the control group ( P<0.01) . At the 16th week of treatment,ES was significantly increased as compared with that before the treatment ( P<0.01) , and there was a significant difference between the treatment group and the control group (P<0.01). Conclusion Iguratimod combined with MTX have a prominent effect on rRA with high safety. The efficacy of IT on RA might be related with decreasing VEGF release,increasing ES production and alleviating synovium angiogenesis.