摘要:
目的 旨在探讨沙立度胺用于治疗类风湿性关节炎的疗效及对趋化因子配体(CCL19)的影响.方法 抽取2016年4月至2017年6月在广州医科大学附属第一医院门诊确诊并接受治疗的120例类风湿性关节炎患者作为观察对象展开研究,纳入标准:均为类风湿性关节炎活动期,且未接受环磷酰胺、甲氨蝶呤等药物治疗,短期内无怀孕意向且未怀孕者;排除标准:合并患心脑血管疾病、服用抗风湿药治疗者以及对实验用药物过敏者.依随机数字表法分为2组,并接受不同方案进行治疗,采集血清样本利用酶联免疫吸附法(ELISA法)检测趋化因子配体(CCL19)的表达,并观察统计治疗前后2组患者临床体征及实验室相关指标表达,包括关节痛指数、关节肿胀指数、晨僵时间、红细胞沉降率(ESR)、C反应蛋白(CRP)情况.并利用独立样本t检验两组患者临床体征、实验相关指标进行统计分析,利用两因素两水平方差分析方法对两组患者血CCL19治疗前后间的差异进行分析,利用χ2检验对类风湿因子、疗效、并发症发生率进行比较分析.结果 与治疗前比,治疗后2组患者临床体征及实验室相关指标均得到显著降低,且观察组患者经沙立度胺治疗其临床各体征与相关指标以及血清CCL19表达(417.55±198.64)均比对照组(574.53±226.53)更低,改善效果比对照组更明显,差异有统计学意义(关节痛指数:t=12.3415,P<0.01;关节肿胀指数:t=13.9137,P<0.01;晨僵时间:t=18.9826,P<0.01;ESR:t=20.8624,P<0.01,CRP:t=21.4424,P<0.01,RF阳性:χ2=9.2593,P<0.01;血清CCL19:F=9.386,P<0.01);观察组治疗总有效率为91.67%显著比对照组(76.67%)更佳,差异有统计学意义(χ2=5.0652,P<0.05).结论 与传统抗风湿药物相比,应用沙立度胺对类风湿性关节炎患者进行治疗,在缓解关节肿胀、疼痛等症状、控制病情发展等方面有显著疗效,且安全性较好,为临床治疗类风湿性关节炎提供新思路.%Objective To investigate the effect of thalidomide on the treatment of rheumatoid arthritis and the effect on chemokine ligand (CCL19).Methods From April 2016 to June 2017,120 patients with rheumatoid arthritis who were diagnosed and treated in the First Affiliated Hospital of Guangzhou Medical University were selected as the observation subjects . Inclusion criteria: active rheumatoid arthritis ,and without drugs such as cyclophosphamide ,methotrexate ,no intention of pregnancy and not pregnant .Exclusion criteria: cardiovascular and cerebrovascular diseases ,taking anti-rheumatic and those who are allergic to experimental drugs .The patients were divided into two groups according to random number table and received different treatment plans .Serum samples were collected for the detection of chemokine ligand ( CCL19 ) by enzyme-linked immunosorbent assay ( ELISA );the clinical signs and laboratory related indicators ,such as joint pain index ,joint swelling index ,morning stiffness time ,erythrocyte sedimentation rate (ESR),C-reaction protein (CRP) were also tested and recorded.The differences of blood CCL 19 between the two groups before and after treatment were analyzed by two-factor two-level analysis of variance .The rheumatoid factor ( RF ) ,therapeutic effect ,complication rate were compared by chi-square analysis.Results Compared with the data before treatment ,the clinical signs and laboratory related indicators of the two groups after the treatment were significantly reduced . The observation group of thalidomide treatment showed less clinical signs and related indicators ,and lower serum CCL19 expression (418 ±199) than the control group (5749 ±226);the improvement effect was more obvious than the control group ,the differences were statistically significant ( joint pain index: t =12.3415,P<0.01;joint swelling index: t=13.9137,P<0.01;morning stiffness time: t =18.9826,P<0.01;ESR:t=20.8624,P<0.01;=21.4424,P<0.01,RF positive:χ2 =9.2593,P<0.01;serum CCL19:F=9.386,P<0.01).The total effective rate of observation group was 91.67%,which was higher than that of control group (76.67%);the difference was statistically significant (χ2 =5.0652,P<0.05 ) .Conclusion Compared with the traditional anti-rheumatic drugs ,thalidomide treatment for with rheumatoid arthritis has significant effect on the symptoms such as joint swelling and pain ,and controlling the disease progression ,which is safe and may provide new ideas for clinical treatment of rheumatoid arthritis .