目的 探究雷公藤多苷片联合依那西普治疗类风湿性关节炎的临床疗效及其对血清14-3-3η蛋白、抗环瓜氨酸肽抗体（Anti-CCP）水平的影响。方法 选取2017年12月-2018年12月秦皇岛市中医医院接收的88例类风湿关节炎患者作为研究对象，按照治疗方法将患者分为对照组（44例）和观察组（44例）。对照组患者皮下注射注射用依那西普，25 mg/次，2次/周。观察组患者在对照组治疗的基础上饭后口服雷公藤多苷片，20 mg/次，3次/d。两组均持续治疗3个月。观察两组患者的临床疗效，同时比较两组治疗前后的临床症状改善情况、血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-17（IL-17）、C反应蛋白（CRP）、红细胞沉降率（ESR）、类风湿因子（RF）、14-3-3η蛋白、anti-CCP及免疫指标水平。统计两组患者的不良反应发生情况和1年复发率。结果 治疗后，观察组总有效率为95.45%，显著高于对照组的79.55%，组间比较差异具有统计学意义（P<0.05）。治疗后，两组晨僵时间、关节压痛数、关节肿胀数、VAS评分均明显降低（P<0.05）；且治疗后，观察组各临床症状改善程度显著低于对照组（P<0.05）。治疗后，两组患者血清TNF-α、IL-6、IL-17、ESR、CRP水平及RF、14-3-3η蛋白、anti-CCP表达均显著降低（P<0.05）；且治疗后观察组上述血清学指标均明显低于对照组（P<0.05）。治疗后，两组患者外周血免疫球蛋白A （IgA）、免疫球蛋白G （IgG）、免疫球蛋白M （IgM）水平均显著降低（P<0.05）；且治疗后，观察组外周血IgA、IgG、IgM水平明显低于对照组（P<0.05）。治疗期间，两组不良反应发生率比较差异无统计学意义。治疗结束后，对患者随访1年，观察组和对照组复发率分别为4.55%和22.73%；组间比较差异具有统计学意义（P<0.05）。结论 雷公藤多苷片联合依那西普治疗类风湿关节炎可提高临床效果，减轻患者临床症状，降低体内炎症指标，调节机体免疫，且不易复发，值得临床上推广应用。

Objective To investigate the clinical efficacy of Tripterygium Glycosides Tablets combined with etanercept in treatment of rheumatoid arthritis and its effect on the expression of serum 14-3-3η protein and anti-CCP. Methods A total of 88 patients with rheumatoid arthritis admitted to Qinhuangdao Hospital of Traditional Chinese Medicine from December 2017 to December 2018 were selected as the research subjects, and the patients were divided into control group (44 cases) and observation group (44 cases) according to the treatment methods. Patients in the control group were subcutaneously injected with Etanercept for injection, 25 mg/time, twice weekly. Patients in the observation group were po administered with Tripterygium Glycosides Tablets after meals on the basis of control group, 20 mg/time, three times daily. The treatment lasted for 3 months in both groups. To observe the clinical efficacy of two groups, and the improvement of clinical symptoms, the levels of TNF-α, IL-6, IL-17, CRP, ESR, RF, 14-3-3η protein, anti-CCP, and immune indexes before and after treatment were compared. The incidence of adverse reactions and 1-year recurrence rate in two groups were analyzed. Results After treatment, the total effective rate of the observation group was 95.45%, which was significantly higher than 79.55% of the control group, and the difference was statistically significant (P<0.05). After treatment, morning stiffness time, number of joint tenderness, number of joint swelling, and VAS score were significantly decreased in two groups (P<0.05). After treatment, the improvement of clinical symptoms in observation group was significantly lower than those in the control group (P<0.05). After treatment, the serum levels of TNF-α, IL-6, IL-17, ESR, CRP, and the expressions of RF, 14-3-3η protein, and anti-CCP in two groups were significantly decreased (P<0.05). After treatment, the above serum indexes in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the levels of peripheral blood IgA, IgG, and IgM in two groups were significantly decreased (P<0.05). After treatment, the levels of IgA, IgG, and IgM in peripheral blood of observation group were significantly lower than those of control group (P<0.05). During treatment, there was no significant difference in the incidence of ADR between two groups. After treatment, patients were followed up for 1 year, the recurrence rate of observation group and control group were 4.55% and 22.73%, respectively, and the difference between groups was statistically significant (P<0.05). Conclusion Tripterygium Glycosides Tablets combined with etanercept in treatment of rheumatoid arthritis can improve the clinical effect, reduce the clinical symptoms of patients, reduce the inflammatory indexes in vivo, regulate the body's immunity, and is not easy to relapse, which is worthy of clinical promotion and application.

R976

秦皇岛市科学技术研究与发展计划项目（201902A006）