【摘要】 目的 研究枸橼酸托法替布(简称托法替布)联合皮内针治疗类风湿性关节炎(RA)的临床效果和安全性。方法 回顾性分析该院2020年1月至2021年12月住院和门诊RA患者150例的相关临床资料。根据不同病情将接受托法替布+改善病情抗风湿药物(DMARDs)+皮内针治疗的患者51例纳入A组；将接受DMARDs+皮内针治疗的患者50例纳入B组；将接受单纯DMARDs治疗的患者49例纳入C组。对患者治疗前和治疗1、2、3个月后的28个关节疾病活动评分(DAS-28)、视觉模拟量表(VAS),以及红细胞沉降率(ESR)、C-反应蛋白(CRP)、关节疼痛(TJC)、肿胀数(SJC)、类风湿因子(RF)、抗环瓜氨酸肽抗体(ACPA)等相关指标和不良反应情况进行统计分析。结果 3组患者治疗前年龄、性别、病程无明显差异(P>0.05)。但A组治疗前DAS-28、VAS,以及ESR、CRP、RF、ACPA水平明显高于B组和C组(P<0.05),B、C组间上述指标比较无明显差异(P>0.05)。治疗1个月后，A组患者DAS-28、VAS,以及CRP、ESR、TJC、SJC较治疗前明显下降(P<0.05),B、C两组上述指标与治疗前比较差异无统计学意义(P>0.05)。治疗3个月后，3组患者DAS-28、VAS,以及ESR、CRP、RF、TJC、SJC均较治疗前明显下降(P<0.05);A、B、C组患者ACR20反应率分别为68.63%、46.00%、30.61%,差异有统计学意义(P<0.05);B组患者ACPA、TJC较C组明显下降(P<0.05),但CRP、VAS、SJC等与C组比较无明显差异(P>0.05)。3组患者治疗前后均未发生严重不良反应，加用皮内针的A、B两组药物不良反应发生率分别为1.96%和2.00%,均低于C组的22.46%,差异有统计学意义(P<0.05)。结论 DMARDs联合托法替布可快速起效，用药1个月后可明显降低疾病活动度，优于DMARDs,且联合皮内针有一定协同作用，能降低药物不良反应。更多还原

【Abstract】 Objective To investigate the clinical efficacy and safety of tofacitinib combined with intradermal acupuncture for the treatment of rheumatoid arthritis(RA).Methods The clinical data of 150 inpatients and outpatients with RA from January 2020 to December 2021 in our hospital were retrospectively analyzed.A total of 51 patients who received tofacitinib+disease-modifying antirheumatic drugs(DMARDs)+intradermal needles were included in group A.Fifty patients who received DMARDs + intradermal needle therapy were included in group B.Forty-nine patients who received DMARDs alone were included in group C.The 28-joint disease activity score(DAS-28),visual analogue scale(VAS) scores, erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),tender joint count(TJC),swollen joint count(SJC),rheumatoid factor(RF),anti-cyclic citrullinated peptide antibody(ACPA),and other related indicators and adverse reactions were statistically analyzed.Results There were no significant differences in age, gender, and disease course among the three groups before treatment(P>0.05).However, the DAS-28,VAS scores, ESR,CRP,RF,and ACPA levels in group A before treatment were significantly higher than those in group B and group C(P<0.05).There was no significant difference in the above indicators between groups B and C(P>0.05).After one month of treatment, the DAS-28,VAS scores, and CRP,ESR,TJC,and SJC of patients in group A were significantly decreased compared to their pre-treatment levels(P<0.05).There was no statistically significant difference in the above indicators between group B and group C compared to those before treatment(P>0.05).After 3 months of treatment, the scores of DAS-28 and VAS,as well as ESR,CRP,RF,TJC,and SJC in the three groups were significantly decreased compared to those before treatment(P<0.05).The ACR20 response rates in group A,group B,and group C were 68.63%,46.00%,and 30.61%,respectively, with statistically significant differences(P<0.05).Compared to group C,the levels of ACPA and TJC in group B were significantly lower(P<0.05).However, there were no significant differences in CRP,VAS score, SJC,etc.between group B and group C(P>0.05).There were no significant adverse reactions observed before and after treatment in the three groups.The incidence of adverse drug reactions in group A and group B,who received intradermal needles, were 1.96% and 2.00% respectively.These rates were lower than the incidence in group C(22.46%).The difference was statistically significant(P<0.05).Conclusion DMARDs combined with tofacitinib can take effect quickly and significantly reduce disease activity after 1 month of medication.This combination is superior to DMARDs alone, and the use of intradermal needles has a certain synergistic effect, which can help reduce adverse drug reactions.更多还原