目的 探討锝[⁹⁹Tc]亞甲基二膦酸鹽注射液聯(lián)合注射用依那西普治療類風(fēng)濕關(guān)節(jié)炎的臨床療效。方法 選取2015年8月—2016年11月濮陽(yáng)市安陽(yáng)地區(qū)醫(yī)院收治的類風(fēng)濕關(guān)節(jié)炎患者92例作為研究對(duì)象，按照隨機(jī)數(shù)字表法分為對(duì)照組和治療組，每組各46例。對(duì)照組皮下注射注射用依那西普，25 mg/次，2次/周。治療組在對(duì)照組基礎(chǔ)上靜脈滴注锝[⁹⁹Tc]亞甲基二膦酸鹽注射液。將A劑與B劑充分混勻后，室溫下靜置5 min，然后加入250 mL生理鹽水，1次/d，10 d為1個(gè)療程，療程之間間歇20 d。兩組患者共治療3個(gè)療程。觀察兩組的臨床療效，比較兩組治療前后兩組的臨床癥狀、炎癥因子水平和骨代謝指標(biāo)。結(jié)果 治療后，對(duì)照組和治療組總有效率分別為71.74%、91.30%，兩組總有效率比較差異有統(tǒng)計(jì)學(xué)意義（P< 0.05）。治療后，兩組腫脹關(guān)節(jié)數(shù)、壓痛關(guān)節(jié)數(shù)、晨僵時(shí)間、疾病活動(dòng)度（DAS28）評(píng)分均明顯降低，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P< 0.05）；且治療組這些觀察指標(biāo)明顯低于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P< 0.05）。治療后，兩組超敏C反應(yīng)蛋白（hs-CRP）、血沉（ESR）、白介素1β（IL-1β）、腫瘤壞死因子α（TNF-α）水平均明顯降低，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P< 0.05）；且治療組這些觀察指標(biāo)明顯低于對(duì)照組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P< 0.05）。治療后，兩組骨堿性磷酸酶（B-ALP）明顯升高，I型膠原氨基末端肽（NTX-I）明顯降低，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P< 0.05）；且治療組骨密度（BMD）、B-ALP、NTX-I的改善明顯優(yōu)于對(duì)照組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P< 0.05）。結(jié)論 锝[⁹⁹Tc]亞甲基二膦酸鹽注射液聯(lián)合注射用依那西普治療類風(fēng)濕關(guān)節(jié)炎的療效確切，能顯著減輕患者炎癥反應(yīng)，改善骨代謝水平，具有一定的臨床推廣應(yīng)用價(jià)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.