托法替布联合雷公藤多苷治疗类风湿关节炎合并间质性肺炎的临床效果

Clinical effect of Tofacitinib combined with tripterygium glycosides in the treatment of rheumatoid arthritis complicated with interstitial pneumonia

摘要:

目的 探讨托法替布联合雷公藤多苷治疗类风湿关节炎合并间质性肺炎的临床效果。方法 选取2021年5月—2023年7月在西安市第五医院就诊的类风湿关节炎合并间质性肺炎患者78例，以随机数字表法将其分成研究组和对照组，各39例。对照组采用托法替布治疗，研究组在对照组基础上接受雷公藤多苷治疗，两组均持续治疗12周。对比两组中医症候评分、临床疗效、肺功能、血气指标、血清学指标及不良反应。结果 研究组治疗前后关节症候评分、肺炎症候评分和总评分的差值均大于对照组（P <0.05）。研究组总有效率高于对照组（P <0.05）。研究组治疗前后每分钟最大通气量、肺一氧化碳弥散量、用力肺活量的差值均大于对照组（P <0.05）。研究组治疗前后动脉血二氧化碳分压、氧合指数、动脉血氧分压的差值均大于对照组（P <0.05）。研究组治疗前后血清转化生长因子-β、Ⅰ型胶原氨基末端肽、干扰素γ、类风湿因子的差值均大于对照组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 托法替布联合雷公藤多苷治疗类风湿关节炎联合间质性肺炎疗效确切，可改善患者肺功能、血气指标，减轻炎症反应，安全可靠，值得临床推广使用。

Abstract:

Objective To evaluate the clinical efficacy of Tofacitinib combined with tripterygium glycosides in rheumatoid arthritis (RA) patients with comorbid interstitial pneumonia (IP).Methods Seventy-eight RA-IP patients admitted to Xi'an Fifth Hospital between May 2021 and July 2023 were randomly allocated via random number table to either the study group (n = 39) or control group (n = 39). The control group received Tofacitinib monotherapy, while the study group received tripterygium glycosides in addition to Tofacitinib. Both groups underwent 12 weeks of treatment. Outcomes included traditional Chinese medicine (TCM) symptom scores, clinical response rates, pulmonary function parameters, arterial blood gas indices, serological biomarkers, and adverse events.Results The study group exhibited significantly greater reductions in joint symptom scores, pulmonary symptom scores, and total TCM scores than the control group (P < 0.05). Superior overall clinical efficacy was observed in the study group (P < 0.05). Improvements in pulmonary function—maximal voluntary ventilation (MVV), diffusing capacity for carbon monoxide (DLCO), and forced vital capacity (FVC)—were significantly greater in the study group (P < 0.05). The study group also demonstrated significantly greater improvements in arterial partial pressure of carbon dioxide (PaCO?), oxygenation index (OI), and arterial partial pressure of oxygen (PaO?) (P < 0.05). More pronounced reductions were observed in the study group for serum transforming growth factor-β (TGF-β), N-terminal telopeptide of type I collagen (NTX), interferon γ (IFN-γ), and rheumatoid factor (RF) levels (P < 0.05). No significant difference in adverse event incidence was observed between groups (P > 0.05).Conclusion Combined Tofacitinib and tripterygium glycosides therapy significantly improves clinical outcomes, pulmonary function, gas exchange, and inflammatory/immunological markers in RA-IP patients, with a comparable safety profile to Tofacitinib monotherapy. This regimen merits clinical application.