目的 探讨锝[⁹⁹Tc]亚甲基二膦酸盐注射液联合注射用依那西普治疗类风湿关节炎的临床疗效。方法 选取2015年8月—2016年11月濮阳市安阳地区医院收治的类风湿关节炎患者92例作为研究对象，按照随机数字表法分为对照组和治疗组，每组各46例。对照组皮下注射注射用依那西普，25 mg/次，2次/周。治疗组在对照组基础上静脉滴注锝[⁹⁹Tc]亚甲基二膦酸盐注射液。将A剂与B剂充分混匀后，室温下静置5 min，然后加入250 mL生理盐水，1次/d，10 d为1个疗程，疗程之间间歇20 d。两组患者共治疗3个疗程。观察两组的临床疗效，比较两组治疗前后两组的临床症状、炎症因子水平和骨代谢指标。结果 治疗后，对照组和治疗组总有效率分别为71.74%、91.30%，两组总有效率比较差异有统计学意义（P< 0.05）。治疗后，两组肿胀关节数、压痛关节数、晨僵时间、疾病活动度（DAS28）评分均明显降低，同组治疗前后比较差异有统计学意义（P< 0.05）；且治疗组这些观察指标明显低于对照组，两组比较差异具有统计学意义（P< 0.05）。治疗后，两组超敏C反应蛋白（hs-CRP）、血沉（ESR）、白介素1β（IL-1β）、肿瘤坏死因子α（TNF-α）水平均明显降低，同组治疗前后比较差异有统计学意义（P< 0.05）；且治疗组这些观察指标明显低于对照组，两组比较差异有统计学意义（P< 0.05）。治疗后，两组骨碱性磷酸酶（B-ALP）明显升高，I型胶原氨基末端肽（NTX-I）明显降低，同组治疗前后比较差异具有统计学意义（P< 0.05）；且治疗组骨密度（BMD）、B-ALP、NTX-I的改善明显优于对照组，两组比较差异有统计学意义（P< 0.05）。结论 锝[⁹⁹Tc]亚甲基二膦酸盐注射液联合注射用依那西普治疗类风湿关节炎的疗效确切，能显著减轻患者炎症反应，改善骨代谢水平，具有一定的临床推广应用价值。

Objective To investigate the effect of Technetium [⁹⁹Tc] Methylenediphosphonate Injection combined with Etanercept for injection in treatment of rheumatoid arthritis. Methods Patients (92 cases) with rheumatoid arthritis in Anyang District Hospital from August 2015 to November 2016 were divided into two groups, each group of 46 cases. Patients in the control group were sc administered with Etanercept for injection, 25 mg/time, twice weekly. Patients in the treatment group were iv administered with Technetium [⁹⁹Tc] Methylenediphosphonate Injection on the basis of the control group. A agent and B agent were mixed, and were placed at room temperature for 5 min. Then the mixture were diluted into normal saline 250 mL, once daily, and 10 d was for a course, and the treatment interval was 20 d. Patients in two groups were treated for three courses. After treatment, the clinical efficacy was evaluated, and clinical symptoms, levels of inflammatory factors, and index of bone metabolism in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 71.74% and 91.30%, respectively, and there was difference between two groups (P < 0.05). After treatment, the number of joint with swelling and tenderness, time of morning stiffness, DAS28 scores were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). After treatment, hs-CRP, ESR, IL-1β, TNF-α were significantly decreased,and the difference was statistically significant in the same group (P < 0.05). And BMD, B-ALP, and NTX-I in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Technetium [⁹⁹Tc] Methylenediphosphonate Injection combined with Etanercept for injection has clinical curative effect in treatment of rheumatoid arthritis, can significantly reduce the inflammatory response, and improve bone metabolism in patients with rheumatoid arthritis, which has a certain clinical application value.