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目的观察TNFα拮抗剂益赛普治疗类风湿关节炎(Rheumatoid arthritis,RA)伴冠心病的临床疗效。方法选取60例确诊为活动期RA并发冠心病患者,随机分为慢作用药物组(30例,接受慢作用药物治疗,并在整个观察期内保持不变)和益赛普组(30例,在原慢作用药物治疗基础上皮下注射益赛普,每次25 mg,每周2次,持续3个月)。分别于治疗前及治疗12个月后采血,应用全自动荧光偏振免疫分析法测定血清同型半胱氨酸(Homocysteine,HCY)水平;评价临床疗效;经胸超声心动图测定冠状动脉血流储备(Coronary flow reserve,CFR);应用高分辨率B超对所有观察对象的肱动脉进行扫查,测定肱动脉内皮依赖性血管舒张率(Flow-mediated dilation rate,FMD);并记录12个月内发生的心血管疾病、不良反应以及肝肾功能的变化。结果益赛普组治疗后与治疗前比较,患者的血清HCY水平显著下降(P<0.05),CFR和FMD显著升高(P<0.05);慢作用药物组治疗后与治疗前比较,HCY、CFR和FMD均有所下降,但差异无统计学意义(P>0.05);与慢作用药物组比较,经益赛普治疗后,患者血清HCY水平显著下降(P<0.05),CFR和FMD显著升高(P<0.05);益赛普组临床症状缓解有效率明显高于慢作用药物组(P<0.05);12个月内,益赛普组主要心血管疾病发生率与慢作用药物组比较明显降低(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论益赛普可以明显缓解RA患者的临床症状,延缓冠心病的进展,减少心血管危险疾病的发生。
Objective To observe the clinical efficacy of TNFα antagonist Yisip in treating rheumatoid arthritis (RA) with coronary heart disease. Methods Sixty patients diagnosed as active RA with coronary heart disease were randomly divided into a slow-acting drug group (30 patients treated with slow-acting drug and remained unchanged throughout the observation period) In the original slow-acting drug treatment based on subcutaneous injection of ixapu, each 25 mg, 2 times a week for 3 months). Blood samples were collected before treatment and after 12 months of treatment. Serum levels of homocysteine (HCY) were measured by automated fluorescence polarization immunoassay. Clinical efficacy was evaluated. Transthoracic echocardiography was used to measure coronary flow reserve Coronary flow reserve (CFR). The brachial arteries of all the subjects were examined by high-resolution B-mode ultrasound to measure the flow-mediated dilation rate (FMD) of the brachial artery. Cardiovascular disease, adverse reactions, and changes in liver and kidney function. Results Compared with pretreatment group, serum HCY level decreased significantly (P <0.05) and CFR and FMD increased significantly (P <0.05) in pre-treatment group and pre-treatment group. Compared with pre-treatment group, HCY, CFR and FMD decreased, but the difference was not statistically significant (P> 0.05). Compared with the slow-acting drug group, the serum HCY level decreased significantly (P <0.05) and CFR and FMD significantly (P <0.05). The effective rate of relieving clinical symptoms was significantly higher in the Yisuipu group than in the slow-acting drug group (P <0.05). Within 12 months, the incidence of major cardiovascular diseases in the Yisipu group was significantly lower than that in the slow-acting drug group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Conclusion Yi-Saipu can significantly alleviate the clinical symptoms of RA patients, delay the progression of coronary heart disease and reduce the incidence of cardiovascular risk diseases.