【摘要】 目的:探讨中药尪痹片联合甲氨蝶呤片对类风湿性关节炎(RA)患者Dickkopf-1蛋白(DKK-1)表达水平及关节滑膜侵蚀的影响。方法:纳入48例符合标准的RA患者,随机编码表法分为研究组和对照组:研究组给予甲氨蝶呤片10 mg/次,1次/周,结合尪痹片(0.5 g/片),4片/次,3次/日;对照组给予同等剂量的甲氨蝶呤片及尪痹片模拟剂。两组均治疗24周。根据病情使用临时止痛药:对乙酰氨基酚,一次1片(0.5 g/片),1 d用量不超过4片,每周使用不超过2 d。治疗24周后,检测比较患者治疗前后循环血血沉(ESR),类风湿因子(RF),C反应蛋白(CRP),抗环化瓜氨酸多肽(CCP)抗体,DDK-1表达水平及DAS28-ESR评分、Sharp评分、MRI骨侵蚀比例评分、水肿容量评分、关节滑膜炎评分。结果:治疗前两组患者的ESR,CRP,CCP,RF,DKK-1,DSA28-ESR,Sharp评分,MRI骨侵蚀评分、骨髓水肿评分及滑膜炎评分差异无统计学意义(P>0.05)。治疗后治疗组ESR,CRP,CCP,RF,DKK-1,DSA28-ESR,MRI滑膜炎评分均较治疗前明显下降(P<0.05)。对照组治疗后ESR,CRP,CCP,DSA28-ESR,MRI滑膜炎评分均较治疗前明显下降(P<0.05)。两组治疗后Sharp评分、MRI骨侵蚀评分及骨髓水肿评分较治疗前差异无统计学意义(P>0.05),治疗后组间比较差异也无统计学意义(P>0.05)。对照组治疗后RF及DKK-1较治疗前差异无统计学意义(P>0.05)。治疗后治疗组CCP,RF,DKK-1及DSA28-ESR与对照组比较差异有统计学意义(P<0.05),且治疗后治疗组ΔDAS-ESR疗效明显优于对照组(P<0.05)。结论:中药尪痹片联合甲氨蝶呤片可明显降低RA患者DDK-1表达水平,从而缓解关节滑膜侵蚀破坏作用,比单独使用甲氨蝶呤片更具优势,值得临床推广应用。更多还原

【Abstract】 Objective:To investigate the effect of Wangbi pill combined with methotrexate on the expression of Dickkopf-1 protein(DKK-1) and synovial erosion in patients with rheumatoid arthritis(RA).Methods:All 48 RA patients were randomly divided into study group and control group:the study group was given methotrexate 10 mg/time,1 time/week,combined with Wangbi pill(0.5 g/tablet),4 tablets/time,3 times/d;the control group was given the same dose of methotrexate and Wangbi pill simulant.Both groups were treated for 24 weeks.Use temporary painkillers according to the condition:acetaminophen,1 tablet(0.5 g/tablet) at a time,the daily dosage was not more than 4 tablets,and the weekly dosage was not more than 2 d.After 24 weeks of treatment,the changes of ESR,RF,CRP,anti CCP antibody and DDK-1 expression in the circulating blood,the DAS28-ESR score,Sharp score,MRI bone erosion ratio score,edema volume score and synovitis score were compared before and after treatment.Results:There was no significant difference in ESR,CRP,CCP,RF,DKK-1,DAS28-ESR,Sharp score,MRI bone erosion score,bone marrow edema score and synovitis score between the two groups(P>0.05).The scores of ESR,CRP,CCP,RF,DKK-1,DAS28-ESR and MRI synovitis score in the treatment group were significantly lower than those before treatment(P<0.05).The level of ESR,CRP,CCP,DAS28-ESR and MRI synovitis score in the control group were significantly lower than those before treatment(P<0.05).There was no significant difference in sharp score,MRI bone erosion score and bone marrow edema score between the two groups after treatment(P>0.05),and there was no significant difference between the two groups after treatment(P>0.05).There was no significant difference in level of RF and DKK-1 between the two groups(P>0.05).After treatment,there were significant differences in CCP,RF,DKK-1 and DAS28-ESR between the treatment group and the control group(P<0.05),and the effect of DAS28-ESR in the treatment group was significantly better than that in the control group(P<0.05).Conclusion:The combination of traditional Chinese medicine and methotrexate can significantly reduce the expression level of DDK-1 in RA patients,so as to alleviate the damage of synovium erosion.It has more advantages than methotrexate alone,so it is worthy of clinical application.更多还原