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目的：探讨依那西普联合甲氨蝶呤治疗类风湿关节炎的疗效。方法：选取2011 年至2013 年风湿免疫科的60例类风湿关节炎患者，分为对照组和治疗组，其中对照组15 例，治疗组45 例，两组患者都应用甲氨蝶呤治疗，治疗组患者联合使用依那西普治疗，总疗程12 周。比较两组患者治疗前后的临床及实验室指标。采用美国风湿病学会的核心标准作为疗效评定标准。结果：治疗组患者肿瘤坏死因子（tumor necrosis factor, TNF）和白细胞介素（interleukin, IL-1）下降明显，与对照组患者相比差异均有统计学意义（P＜0.05）；治疗后两组患者超敏C反应蛋白(hs-CRP)均较治疗前明显降低，差异均有统计学意义（P＜0.05）；治疗组患者关节疼痛、关节肿胀和晨僵情况较对照组均有显著的改善（P＜0.05）；治疗组患者的休息痛、患者评分以及HAQ评分均显著优于对照组（P＜0.05）；治疗组患者ACR20 和ACR70 缓解的比例均高于对照组，且治疗组患者达ACR50 缓解的比例显著高于对照组（P＜ 0.05）。结论：依那西普联合甲氨蝶呤治疗类风湿关节炎的疗效优于单纯的甲氨蝶呤治疗。

英文摘要:

Objective:To explore the curative effect of etanercept combined with methotrexate in the treatment of rheumatoid arthritis (RA).Methods:60 patients with RA were selected from 2011 to 2013 and divided into the control group and treatment group. 15 patients in control group and 45 patients in treatment group were all treated with methotrexate, what’s more, the patients of treatment group were treated with etanercept at the same time. The course of treatment was 12 weeks. The clinical and laboratory indexes of these two groups of patients before and after the treatment were compared .The American College of Rheumatology (ACR) criteria was used for clinical assessments.Results:The TNF and IL-1 of the treatment group significantly decreased and had statistical significance , when compared with patients of control group (P＜0.05). The hs-CRP of both two groups were significantly reduced after treatment (P＜0.05). The joint pain, joint swelling and morning stiffness of the treatment group were significantly improved than in control group (P＜0.05). The rest pain, patients' VAS and HAQ scores of the treatment group were significantly better than those of control group (P＜0.05). The ACR20, ACR70 responses of the treatment group were better than those of control group, and the ACR50 responses were significantly better than those of control group (P＜0.05).Conclusion:Compared with methotrexate, etanercept combined with methotrexate had significant efficacy in patients with RA.

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