枸橼酸托法替布片联合艾拉莫德治疗类风湿关节炎的效果及对IL-21/STAT3信号通路的影响OA
Effect of tofacitinib citrate tablets combined with iguratimod in treatment of rheumatoid arthritis and its influence on IL-21/STAT3 signaling pathway
目的:探讨枸橼酸托法替布片联合艾拉莫德治疗类风湿关节炎(RA)的效果,并分析其对临床症状体征、炎症反应、IL-21/STAT3信号通路的影响.方法:选取2022年1月至2023年9月就诊于郑州大学第五附属医院的RA患者110例,分为对照组、观察组,各55例.对照组给予艾拉莫德+甲氨蝶呤治疗,观察组给予枸橼酸托法替布片+艾拉莫德+甲氨蝶呤治疗,连续治疗12周.比较两组治疗效果及治疗前后临床症状改善情况,以及血清IL-21/STAT3信号通路因子(IL-21、p-STAT3、STAT3)、炎症指标、骨代谢指标水平、不良反应发生情况.结果:观察组总有效率为94.55%,高于对照组的80.00%(P<0.05);观察组治疗后晨僵时间、关节肿胀数、关节压痛数、VAS评分低于对照组(P<0.05);观察组治疗后血清IL-21、p-STAT3、STAT3水平低于对照组(P<0.05),ESR、血清RF、CRP、TNF-α水平低于对照组(P<0.05),血清骨钙素N端中分子(N-MID)、总Ⅰ型胶原氨基端延长肽(TPⅠNP)水平高于对照组,β-胶原降解产物(β-CTX)水平低于对照组(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:枸橼酸托法替布片联合艾拉莫德治疗RA患者可提高临床疗效,改善临床症状,减轻疼痛程度,抑制炎症反应,改善骨代谢水平,且具有一定安全性,其作用机制可能与抑制IL-21/STAT3信号通路有关.
Objective:To investigate the efficacy of tofacitinib citrate tablets combined with iguratimod in treatment of rheuma-toid arthritis(RA),and to analyze its effects on clinical symptoms and signs,inflammatory response,IL-21/STAT3 signaling pathways.Methods:A total of 110 patients with RA who were treated at the Fifth Affiliated Hospital of Zhengzhou University from January 2022 to September 2023 were were selected and divided into control group and observation group,with 55 cases in each group.Control group received iguratimod combined with methotrexate,while observation group received tofacitinib citrate tablets combined with iguratimod and methotrexate for 12 consecutive weeks.Therapeutic efficacy and improvements in clinical symptoms before and after treatment were compared between the two groups.Furthermore,serum IL-21/STAT3 signaling pathway factors(IL-21,p-STAT3,STAT3),inflammatory indexes,bone metabolism indexes,and adverse reactions were assessed.Results:Total effective rate of observation group was 94.55%,which was higher than that of control group(80.00%)(P<0.05).After treatment,morning stiffness duration,number of swollen joints,number of tender joints,and VAS score in observation group were significantly lower than those in control group(P<0.05).Serum levels of IL-21,p-STAT3 and STAT3 in observation group were also lower than those in control group after treatment(P<0.05).Furthermore,observation group exhibited lower levels of ESR,serum RF,CRP and TNF-α(P<0.05),higher levels of serum N-terminal mid-molecule osteocalcin(N-MID)and total type Ⅰ procollagen amino-terminal propeptide(TPⅠNP),and lower level of β-C-terminal telopeptide of type Ⅰ collagen(β-CTX)compared to control group(P<0.05).There was no significant difference in adverse reactions rate between the two groups(P>0.05).Conclusion:Combination of tofacitinib citrate tablets and iguratimod for treating RA patients improves clinical efficacy,alleviates clinical symptoms and pain,suppresses inflammatory responses,and ameliorates bone metabolism,with acceptable safety.Its therapeutic mechanism may be associated with the inhibition of IL-21/STAT3 signaling pathway.
任丽丽;韩田;孟洋;丁艳霞
郑州大学第五附属医院风湿免疫科,郑州 450052郑州大学第五附属医院风湿免疫科,郑州 450052郑州大学第五附属医院风湿免疫科,郑州 450052郑州大学第一附属医院,郑州 450000
医药卫生
类风湿关节炎枸橼酸托法替布片艾拉莫德疗效骨代谢炎症因子
Rheumatoid arthritisTofacitinib citrate tabletsIguratimodCurative effectBone metabolismInflammatory factor
《中国免疫学杂志》 2026 (8)
1815-1820,6
河南省医学科技攻关计划联合共建项目(LHGJ20190062).
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