中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (12): 820-823.doi: 10.3969/j.issn.1671-4091.2020.12.007

• 临床研究 • 上一篇    下一篇

双重血浆置换联合甲氨蝶呤治疗类风湿关节炎的疗效

赵宁1,杨东星2,卢伟伟1,刘芳1,于笑霞1,田俊阁1,徐萍1   

  1. 河北省沧州中西医结合医院1风湿一科2重症医学科
  • 收稿日期:2020-05-08 修回日期:2020-09-16 出版日期:2020-12-12 发布日期:2020-12-08
  • 通讯作者: 赵宁 xiaoying20207@126.com E-mail:xiaoying20207@126.com
  • 基金资助:
    沧州市重点研发计划指导项目课题：双重血浆置换联合慢作用抗风湿药治疗类风湿关节炎临床研究(183302085)

Efficacy of double filtration plasmapheresis combined with methotrexate in the treatment of rheumatoid arthritis

  1. 1Department of Rheumatology and 2Department of ICU, Cangzhou Traditional Chinese and Western Medicine Integrated Hospital, Cangzhou 061000, China
  • Received:2020-05-08 Revised:2020-09-16 Online:2020-12-12 Published:2020-12-08

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摘要： 【摘要】目的探索双重血浆置换(double filtration plasmapheresis，DFPP)联合甲氨蝶呤(methotrexate, MTX)治疗类风湿关节炎(rheumatoid arthritis, RA)的疗效。方法2016 年4 月～2017 年5月RA 患者120 例，随机分为对照组和观察组，每组60 例。对照组给予甲氨蝶呤和来氟米特治疗。观察组在对照组治疗基础上给予DFPP。监测2 组患者治疗前后炎症因子、Dickkopf-1(DKK1)、核因子κ-B 受体活化因子配体(nuclear factor κ-B receptor activation factor ligands,RANKL)水平以及关节症状变化，并进行对比分析。结果治疗后2 组患者DKK1 增加(t=4.112，P＜0.001)，RANKL、白细胞介素6、肿瘤坏死因子α、类风湿因子、C 反应蛋白、红细胞沉降率、疼痛关节数和肿胀关节数水平下降，观察组的变化程度大于对照组(t 值分别为2.208，3.926，10.320，35.509，7.233，42.563，9.603，6.056；P 值分别为＜0.001，＜0.001，＜0.001，＜0.001，＜0.001，＜0.001，＜0.001，＜0.001)；观察组患者不良反应总数明显低于对照组(χ2=3.159，P=0.047)。2 组间白细胞、血小板、白蛋白差异无统计学意义(P＞0.05)。结论DFPP 联合MTX治疗促使血清DKK1 升高，降低RANKL 和炎症因子，改善临床症状。

关键词: 双重血浆置换, 类风湿关节炎, Dickkopf-1, RANKL

Abstract: 【Abstract】Objective To explore the efficacy of double filtration plasmapheresis (DFPP) combined with methotrexate (MTX) in the treatment of rheumatoid arthritis (RA). Methods A total of 120 RA cases treated during April 2016 to May 2017 were randomly divided into control group (n=60) and observation group (n=60). Patients in control group were treated with MTX and Leflunomide. The levels of inflammatory factors, Dickkopf-1 (DKK1) and nuclear factor κ-B receptor activation factor ligand (RANKL), and joint symptoms were monitored before and after treatment in the two groups. Results After the treatment, DKK1 (t=4.112, P=0.000) increased; RANKL (t=2.208, P=0.000), IL-6 (t=3.926, P=0.000), TNF-α (t=10.320, P=0.000), RF(t= 35.509,  P=0.000), CRP (t=7.233, P=0.000), ESR (t=42.563, P=0.000), number of painful joints (t=9.603, P=0.000) and swollen joints (t=6.056, P=0.000) decreased in the two groups. The degrees of the changes were greater in observation group than in control group (P<0.05). The total number of the adverse reactions was significantly lower in observation group than in control group (c2=3.159, P=0.047). There were no significant differences in WBC, platelet and albumin between the two groups before and after treatment (P＞0.05). Conclusion DFPP combined with MTX treatment increased serum DKK1, reduced RANKL and inflammatory
factors, and improved clinical symptoms.

Key words: Double filtration plasmapheresis, Rheumatoid arthritis, Dickkopf-1, NF κ-B receptor activation factor ligand

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