目的 探究阿達(dá)木單抗注射液聯(lián)合艾拉莫德治療類(lèi)風(fēng)濕關(guān)節(jié)炎的臨床效果。方法 選取2019年4月—2023年4月在馬鞍山市人民醫(yī)院進(jìn)行治療的類(lèi)風(fēng)濕性關(guān)節(jié)炎患者81例，根據(jù)患者治療方案差異將患者分成對(duì)照組（40例）和治療組（41例）。對(duì)照組飯后口服艾拉莫德片，25 mg/次，2次/d；治療組在對(duì)照組基礎(chǔ)上皮下注射阿達(dá)木單抗注射液，40 mg/次，1次/2周。兩組患者均進(jìn)行12周的治療。觀察兩組患者臨床療效，比較治療前后兩組患者WHOQOL-BREF和VAS評(píng)分，臨床癥狀改善時(shí)間，血清炎性因子白介素-1β（IL-1β）、腫瘤壞死因子-α（TNF-α）、γ-干擾素（IFN-γ）、脂聯(lián)素（ADPN）、降鈣素基因相關(guān)肽（CGRP）和Ⅱ型膠原C端肽（CTX-Ⅱ）水平。結(jié)果 治療后，對(duì)照組和治療組臨床總有效率分別為80.00%、95.12%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。治療后，兩組患者VAS評(píng)分顯著下降，而WHOQOL-BREF評(píng)分顯著上升（P＜0.05），且治療組患者WHOQOL-BREF和VAS評(píng)分明顯好于對(duì)照組（P＜0.05）。治療后，治療組患者關(guān)節(jié)晨僵、關(guān)節(jié)腫脹、關(guān)節(jié)疼痛和關(guān)節(jié)活動(dòng)受限癥狀改善時(shí)間均明顯短于對(duì)照組（P＜0.05）。治療后，兩組患者血清炎性因子IL-1β、TNF-α、IFN-γ和CTX-Ⅱ水平顯著降低，而ADPN和CGRP水平顯著升高（P＜0.05），且治療組血清指標(biāo)改善明顯好于對(duì)照組（P＜0.05）。結(jié)論 阿達(dá)木單抗注射液聯(lián)合艾拉莫德片治療類(lèi)風(fēng)濕關(guān)節(jié)炎療效顯著，不僅能夠顯著改善患者臨床癥狀、炎癥因子水平和生存質(zhì)量，同時(shí)還能夠促進(jìn)血清學(xué)指標(biāo)的恢復(fù)且并未增加明顯不良反應(yīng)。

Objective To investigate the clinical effect of Adalimumab Solution for injection combined with iguratimod in treatment of rheumatoid arthritis. Methods Patients (81 cases) with rheumatoid arthritis in Ma’anshan People’s Hospital from April 2019 to April 2023 were divided into control (40 cases) and treatment (41 cases) group based on different treatments. Patients in the control group were po administered with Iguratimod Tablets after meals, 25 mg/time, twice daily. Patients in the treatment group were subcutaneous injection administered with Adalimumab Solution for injection on the basis of the control group, 40 mg/time, once every 2 weeks. Patients in two groups were treated for 12 weeks. After treatment, the clinical evaluations were evaluated, the scores of WHOQOL-BREF and VAS, the improvement time of clinical main symptoms, the levels serum inflammatory factor IL-1β, TNF-α, IFN-γ, ADPN, CGRP and CTX-Ⅱ in two groups before and after treatment were compared. Results After treatment, the clinical effective rates in the control group and the treatment group were 80.00% and 95.12% respectively, and the difference between two groups was statistically significant (P < 0.05). After treatment, the VAS scores in two groups were significantly decreased, while the WHOQOL-BREF were scores significantly increased (P < 0.05), and the WHOQOL-BREF and VAS scores in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the improvement time for morning stiffness, joint swelling, joint pain and limited joint activity in the treatment group was significantly shorter than that in the control group (P < 0.05). After treatment, the levels of serum inflammatory factors IL-1β, TNF-α, IFN-γ and CTX-Ⅱ were significantly reduced in two groups, while the levels of ADPN and CGRP were significantly increased (P < 0.05), and the improvement of serum indicators in the treatment group was significantly better than that in the control group (P < 0.05). Conclusion Adalimumab Solution for injection combined with Iguratimod Tablets has significant efficacy in the treatment of rheumatoid arthritis, which can not only significantly improve the clinical symptoms, inflammatory factor levels and quality of life, but also promote the recovery of serological indicators without increasing significant adverse reactions.

R977

安徽省自然科學(xué)基金資助項(xiàng)目（2008085QH386）