沙利度胺治疗类风湿关节炎的效果观察及对血清Cys-C VEGF水平的影响

doi:10.3969/j.issn.1006-6233.2020.05.004

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摘要 目的:研究沙利度胺治疗类风湿关节炎的效果观察及对血清胱抑素C(Cys-C)、血管内皮生长因子(VEGF)水平的影响。方法:选取2017年3月至2018年2月的96例类风湿关节炎患者。按照简单随机数表法分为观察组(n=50)和对照组(n=46),对照组采用甲氨蝶呤治疗,观察组在对照组的基础上,采用沙利度胺治疗。观察两组治疗疗效,临床症状改善情况、相关指标水平、骨代谢指标、血清Cys-C、VEGF水平。结果:治疗后,观察组总有效率显著高于对照组[96.00%(48/50)vs76.08%(35/46)](P<0.05);关节压痛指数、关节肿胀指数、晨僵时间均显著低于对照组[(1.71±0.50)vs(5.90±1.42),(1.42±0.32)vs(5.61±1.27),(8.03±1.20)min vs(21.74±5.40)min](P<0.05);ESR、CRP水平均显著低于对照组[(3.05±0.92)mm/h vs(17.43±4.13)mm/h,(4.02±0.67)mg/L vs(12.01±1.35)mg/L](P<0.05);N-MID、T-PINP均显著高于对照组[(20.13±3.72)mg/mL vs(14.63±2.70)mg/mL,(47.30±6.51)mg/mL vs(38.46±5.17)mg/mL](P<0.05);β-CTX均显著低于对照组[(0.46±0.10)pg/mL vs(0.72±0.16)pg/mL](P<0.05);Cys-C、VEGF水平均显著低于对照组[(0.67±0.12)mg/L vs(1.35±0.30)mg/L,(32.76±7.42)μmoL/L vs(50.95±10.64)μmoL/L](P<0.05)。结论:沙利度胺在改善类风湿关节炎患者的临床症状及骨代谢效果显著,可调节免疫,降低Cys-C、VEGF水平,不良反应少,安全可靠。

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	陈冠亚
	谢晔

关键词 ：类风湿关节炎, 沙利度胺, 免疫平衡, 炎性介质

Abstract：Objective: To study the therapeutic effect of thalidomide on rheumatoid arthritis and its effect on serum levels of Cystatin C (Cys-C)and vascular endothelial growth factor (VEGF). Methods: 96 rheumatoid arthritis patients who received therapy from March 2017 to February 2018 in our hospital were selected as research objects. According to random number table method,those patients were divided into the observation group (n=50) and the control group (n=46). The control group was treated with methotrexate, and the observation group was treated with both methotrexate and thalidomide. Then the therapeutic efficacy, improvement of clinical symptoms, levels of related indicators, bone metabolism indicators, serum levels of Cys-C and vascular endothelial growth factor of two groups after treatment were compared. Results:After treatment, the total effective rate of observation group was significantly higher than that of control group[96.00%(48/50)vs76.08%(35/46)](P＜0.05). Joint tenderness index, joint swelling index and morning stiffness time were significantly lower than those in the control group[(1.71±0.50)vs (5.90±1.42),(1.42±0.32)vs (5.61±1.27),(8.03±1.20)min vs (21.74±5.40)min](P＜0.05). The levels of ESR and CRP were significantly lower than those of the control group[(3.05±0.92)mm/h vs (17.43±4.13)mm/h,(4.02±0.67)mg/L vs (12.01±1.35)mg/L](P＜0.05). N-MID and T-PINP were significantly higher than those in the control group[(20.13±3.72)mg/mL vs (14.63±2.70)mg/mL,(47.30±6.51)mg/mL vs (38.46±5.17)mg/mL](P＜0.05). The level of beta-CTX was significantly lower than that of the control group[(0.46±0.10)pg/mL vs (0.72±0.16)pg/mL](P＜0.05). Cys-C and vascular endothelial growth factor levels were significantly lower than those in the control group[(0.67±0.12)mg/L vs (1.35±0.30)mg/L,(32.76±7.42)μmol/L vs(50.95±10.64)μmol/L](P＜0.05).Conclusion:Thalidomide can improve the clinical symptoms and bone metabolism of patients with rheumatoid arthritis. It can regulate immunity, reduce the levels of Cys-C and VEGF. It has less adverse reactions and is safe and reliable.

Key words： Rheumatoid arthritis Thalidomide Immune balance Inflammatory mediators

基金资助:湖北省咸宁市卫生局资助基金,(编号:20162617)

引用本文:

陈冠亚, 谢晔. 沙利度胺治疗类风湿关节炎的效果观察及对血清Cys-C VEGF水平的影响[J]. 河北医学, 2020, 26(5): 717-721.
CHEN Guanya, XIE Ye. Therapeutic Effect of Thalidomide on Rheumatoid Arthritis and Its Effect on Serum Levels of Cys-C and Vascular Endothelial Growth Factor. HeBei Med, 2020, 26(5): 717-721.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.05.004 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I5/717