摘要
目的 研究难治性类风湿性关节炎患者采用甲氨蝶呤联合托法替布方案进行治疗的临床效果。方法 选择在我院接受治疗的300例难治性类风湿性关节炎患者，根据治疗方案的不同将其分成甲、乙、丙三组，采用来氟米特联合甲氨蝶呤治疗的100例患者为甲组，采用益赛普联合甲氨蝶呤治疗的100例患者为乙组（这里的分组和后面方法中的分组不同，分组甲乙组治疗方案不同），采用托法替布联合甲氨蝶呤治疗的100例患者为丙组。对比三组研究对象药物治疗效果、治疗前后调节性T细胞、T细胞、B细胞、炎症因子、骨破坏程度评分、疼痛程度评分、药物不良反应情况。结果 丙组药物治疗总有效率高于乙组，组间数据比较P＜0.05；治疗前后CD4+、CD8+、 CD4+/CD8+值、炎症因子、骨破坏程度评分、疼痛程度评分的改善幅度大于对照组，组间数据比较P＜0.05。上述指标数据乙组与甲组组间比较，差异无统计学意义P＞0.05。结论 难治性类风湿性关节炎患者采用甲氨蝶呤联合托法替布方案进行治疗，能够显著改善调节性T细胞、T细胞、B细胞、炎症因子、骨破坏程度，迅速减轻疼痛，减少药物不良反应，使治疗总有效率提高。
关键词： 难治性类风湿性关节炎；甲氨蝶呤；托法替布；骨破坏
Abstract
Objective To study the clinical effect of methotrexate combined with tofacitinib in patients with refractory rheumatoid arthritis. Methods 300 patients with refractory rheumatoid arthritis who received treatment in our hospital were selected and divided into three groups: A, B and C according to different treatment plans. 100 patients were treated with leflunomide combined with methotrexate. The patients are group A, and 100 patients treated with Yisaipu combined with methotrexate are group B (the grouping here is different from the grouping in the following method, and the treatment plan of group A and B is different), and tofacitinib combined with methotrexate The 100 patients treated with pterin were group C. The drug treatment effects, regulatory T cells, T cells, B cells, inflammatory factors, bone destruction score, pain score, and adverse drug reactions were compared among the three groups of subjects before and after treatment. Results The total effective rate of drug treatment in group C was higher than that in group B, P<0.05 for the comparison of data between groups; CD4+, CD8+, CD4+/CD8+ values, inflammatory factors, bone destruction score, and pain score before and after treatment improved more than those in the control group. Data comparison between groups P<0.05. There was no significant difference in the above index data between group B and group A, P>0.05. Conclusion The treatment of patients with refractory rheumatoid arthritis with methotrexate combined with tofacitinib can significantly improve regulatory T cells, T cells, B cells, inflammatory factors, and bone destruction, rapidly reduce pain, and reduce Adverse drug reactions increase the overall effective rate of treatment.
Key words： Refractory rheumatoid arthritis; Methotrexate; tofacitinib; Bone destruction
参考文献 References
[1] 梅序桥，吴阿阳，郑燕苹，等．类风湿关节炎患者外周血T淋巴细胞亚群CD4+/CD8+表达的意义[J]．检验医学与临床，2015，12(21):3144－3149．
[2] 胡晓敏，宗英，余珊珊，等．类风湿关节炎治疗药物的研发进展及趋势[J]．中国新药杂志，2017，10(1):36－43．
[3] 张向东，王彩虹．沙利度胺联合甲氨蝶呤和来氟米特治疗重度类风湿关节炎的效果观察[J]．医学理论与实践，2016,29(19):3372-3373.
[4] 付迪，谢颖颖，肖楚吟，等．沙立度胺用于类风湿性关节炎的疗效及对趋化因子配体的影响[J]．中华关节外科杂志（电子版），2017,11(6):617-621.
[5] 韦隽,陈庆云.托法替布联合来氟米特治疗类风湿性关节炎疗效分析[J].临床医药文献电子杂志,2020,14(47)：159-160.
[6] 中华医学会风湿病学分会.2018中国类风湿关节炎诊疗指南[J].临床医学研究与实践，2018,3（12）：201.
[7] 张惠琴，丰航，范志勇，等．沙利度胺联合甲氨喋呤与羟氯喹治疗类风湿关节炎的疗效分析[J]．现代生物医学进展，2017,17(15):2949-2950.
[8] 陈晓宇. 来氟米特与甲氨蝶呤联用对治疗类风湿性关节炎患者的临床疗效与安全性及其对炎症因子水平的影响[J]. 抗感染药学,2018,15(9):1609-1611.
[9] 聂婷婷,赵向聪,李军霞,等. 甲氨蝶呤或来氟米特联合环磷酰胺治疗类风湿关节炎的临床研究及对外周血白细胞介素-6 核因子κB 受体活化因子配体表达的影响[J]. 中国药物与临床,2018,18(11):1873-1877.
[10] 周文旭，方堃，谭湘淑，等．甲氨蝶呤对类风湿性关节炎大鼠滑膜细胞凋亡基因调控的实验研究[J]．陕西医学杂志，2018,47(4):411-412.
[11] 吴素叶，薛阿利，赵朴，等．沙利度胺联合甲氨蝶呤对类风湿性关节炎患者外周血调节性Ｔ细胞及细胞因子IL-6表达的调节作用[J]．中国生化药物杂志，2016,36(11)：47-49.
[12] 罗东萍,刘秀梅,傅自力,郝轶群,王凯,杨波,杨洁.他克莫司联合甲氨蝶呤治疗难治性类风湿关节炎临床分析[J].中华风湿病学杂志,2017,(第3期)：185-187.
[13] 张敏,谭震,马艳,等.托珠单抗联合cDMARDs治疗难治性类风湿关节炎的疗效及安全性评估[J].中华疾病控制杂志,2018,11(2)：211-214.
[14] 于守杰,贾倩.艾拉莫德联合依那西普治疗难治性类风湿关节炎的疗效[J].医学信息,2020,12(9)：140-141.
[15] 赵龙姝,辛婕琛，孙丽华等.免疫吸附治疗难治性类风湿关节炎的临床应用[J].中国血液净化,2017,16(10):681-714.