摘要
目的分析类风湿关节炎(RA)患者应用阿达木单抗治疗对血清微小核糖核酸-141(miR-141)、微小核糖核酸-335-5p(miR-335-5p)和骨代谢指标的影响,为临床合理制定治疗方案提供依据。方法选取我院2021年4月至2024年3月收治的RA患者82例作为研究对象,按照随机数字表法将其分为甲氨蝶呤组(41例)和阿达木单抗组(41例)。甲氨蝶呤组给予甲氨蝶呤片口服治疗,阿达木单抗组在甲氨蝶呤组的基础上给予阿达木单抗注射液皮下注射治疗,2组均持续治疗3个月。统计治疗3个月后的疗效、症状改善情况和治疗期间的不良反应;酶联免疫吸附试验检测治疗前和治疗3个月后的炎症反应、血清ACPA、RF和骨代谢指标水平;荧光定量PCR法检测治疗前和治疗3个月后的血清miR-141、miR-335-5p。结果阿达木单抗组治疗3个月后的总有效率(90.24%)高于甲氨蝶呤组(73.17%)(P<0.05)。较治疗前,2组治疗3个月后的晨僵时间缩短,阿达木单抗组较甲氨蝶呤组缩短(P<0.05);2组压痛、肿胀关节数、视觉模拟评分法(VAS)、28个关节疾病活动度(DAS28)评分、血清白细胞介素-22(IL-22)、白细胞介素-17(IL-17)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、miR-141、抗环瓜氨酸肽抗体(ACPA)、类风湿因子(RF)水平降低,阿达木单抗组较甲氨蝶呤组降低(P<0.05);2组血清miR-335-5p、25羟维生素D、骨钙素(BGP)、骨钙素N端中分子片段(N-MID)、骨碱性磷酸酶(B-ALP)水平升高,阿达木单抗组较甲氨蝶呤组升高(P<0.05)。阿达木单抗组治疗期间的不良反应总发生率(7.32%)低于甲氨蝶呤组(24.39%)(P<0.05)。结论阿达木单抗可调节RA患者炎症反应指标、血清miR-141、miR-335-5p、ACPA、RF及骨代谢指标水平,促进症状的改善,进而有助于提高疗效,且具有较好的安全性。
Objective To analyze the effects of adalimumab treatment on serum micro ribonucleic acid-141(miR-141),micro ribonucleic acid-335-5p(miR-335-5p),and bone metabolism indexes in patients with rheumatoid arthritis(RA),and to provide a basis for the rational development of clinical treatment plans.Methods 82 cases of patients with RA admitted to our hospital from April 2021 to March 2024 were selected as study subjects,and they were divided into the methotrexate group(41 cases)and the adalimumab group(41 cases)by randomized numerical table method.The methotrexate group was treated with methotrexate tablets orally,and the adalimumab group was treated with adalimumab injection subcutaneously on the basis of methotrexate group,and both groups continued the treatment for 3 months.The efficacy after 3 months of treatment,symptom improvement and adverse reactions during the treatment period were counted;enzyme-linked immunosorbent assay detected the levels of inflammatory response,serum ACPA,RF and bone metabolism indexes before and after 3 months of treatment;and fluorescence quantitative PCR assay detected serum miR-141,miR-335-5p before and after 3 months of treatment.Results The total effective rate after 3 months of treatment was higher in the adalimumab group(90.24%)than in the methotrexate group(73.17%)(P<0.05).Compared with before treatment,the duration of morning stiffness was shorter in both groups after 3 months of treatment,and it was shorter in the adalimumab group than in the methotrexate group(P<0.05);pressure pain,number of swollen joints,scores of visual analog score(VAS),28 joints disease activity(DAS28),levels of serum interleukin-22(IL-22),interleukin-17(IL-17),C-reactive protein(CRP),tumor necrosis factorα(TNF-α),miR-141,anti-cyclic citrullinated peptide antibody(ACPA),rheumatoid factor(RF)decreased in both groups,and decreased in the adalimumab group compared with the methotrexate group(P<0.05);levels of serum miR-335-5p,25 hydroxyvitamin D,osteocalcin(BGP),osteocalcin N-terminal intermediate molecular fragment(N-MID),and bone alkaline phosphatase(B-ALP)were elevated in both groups,and increased in the adalimumab group compared with the methotrexate group(P<0.05).The overall incidence of adverse reactions during treatment was lower in the adalimumab group(7.32%)than in the methotrexate group(24.39%)(P<0.05).Conclusion Adalimumab could regulate the levels of inflammatory response indicators,serum miR-141,miR-335-5p,ACPA,RF,and bone metabolism indicators in patients with RA,and promote the improvement of symptoms,which in turn contributes to the improvement of therapeutic efficacy and had a high safety profile.
作者
盛娇娥
苏林冲
高圳昱
SHENG Jiao'e;SU Linchong;GAO Zhenyu(Graduate School,Jinzhou Medical University,Jinzhou 121001,China;Department Rheumatology and Immunology,Hubei University for Nationalities Affiliated Minzu Hospital,Enshi 445000,China)
出处
《免疫学杂志》
2025年第3期187-192,共6页
Immunological Journal
基金
湖北省重点实验室2023年度开放基金(PT022311)。
关键词
类风湿关节炎
阿达木单抗
微小核糖核酸
抗环瓜氨酸肽抗体
类风湿因子
骨代谢
Rheumatoid arthritis
Adalimumab
Microribonucleic acid
Anti-cyclic citrullinated peptide antibody
Rheumatoid factor
Bone metabolism
