目的 探討锝-亞甲基二膦酸鹽聯(lián)合甲氨蝶呤治療類風濕關節(jié)炎（RA）的效果。方法 采用回顧性、便利抽樣研究方法，2016年1月-2018年3月選擇在攀枝花市中心醫(yī)院診治的RA患者128例作為研究對象，根據(jù)治療方法的不同分為觀察組與對照組各64例，對照組給予甲氨蝶呤治療，觀察組給予锝-亞甲基二膦酸鹽聯(lián)合甲氨蝶呤治療，兩組都治療觀察3個月，比較兩組的臨床療效，記錄兩組在治療期間出現(xiàn)的消化道癥狀、口腔潰瘍、失眠、肝腎功能異常等不良反應情況，記錄兩組治療后的關節(jié)腫脹數(shù)、關節(jié)壓痛數(shù)，比較兩組治療前后的白介素-6（IL-6）及腫瘤壞死因子-α（TNF-α）水平。結果 所有患者都順利完成治療，觀察組與對照組的治療總有效率分別為100.0%和89.1%，觀察組高于對照組，差異有統(tǒng)計學意義（P<0.05）。觀察組與對照組治療期間的消化道癥狀、口腔潰瘍、失眠、肝腎功能異常等不良反應發(fā)生率分別為14.1%和12.5%，兩組對比差異無統(tǒng)計學意義。觀察組治療后的關節(jié)腫脹數(shù)、關節(jié)壓痛數(shù)顯著少于對照組，差異有統(tǒng)計學意義（P<0.05）。治療后兩組血清IL-6、TNF-α水平顯著低于治療前，同組治療前后比較差異有統(tǒng)計學意義（P<0.05），觀察組也低于對照組，差異有統(tǒng)計學意義（P<0.05）。結論 锝-亞甲基二膦酸鹽聯(lián)合甲氨蝶呤治療RA能抑制炎癥因子的釋放，能改善患者的關節(jié)功能障礙，提高治療療效，且不會增加不良反應的發(fā)生，有很好的應用價值。

Objective To explore the effect of technetium methylenediphosphonate combined with methotrexate in the treatment of rheumatoid arthritis (RA). Methods From January 2016 to March 2018, used a retrospective and convenient sampling method, 128 patients with RA were selected and were divided into the study group and the control group of 64 cases in each groups accorded to the different treatment methods. The control group were treated with methotrexate, and the observation group were given technetium methylenediphosphonate combined with methotrexate treatment. The two groups were treated for 4 weeks, and the prognosis were recorded. Results All patients completed the treatment successfully, the total effective rates of the study group and the control group were 100.0% and 89.1% respectively, and the study group were higher than that of the control group (P<0.05). The incidence of alimentary tract symptoms, oral ulcers, insomnia and abnormal liver and kidney function in the study group and the control group were 14.1% and 12.5% respectively during the treatment, and there were no significant difference compared between the two groups. The number of joint swelling and joint tenderness after treatment in the study group were significantly less than those in the control group (P<0.05). After treatment, serum IL-6 and TNF-α levels of the two groups were significantly lower than those before treatment (P<0.05), and the study group were also lower than that of the control group (P<0.05). Conclusion The technetium methylenediphosphonate combined with methotrexate in treatment of RA can inhibit the release of inflammatory factors, improve the patients' joint dysfunction, improve the therapeutic effect, and will not increase the occurrence of adverse reactions.

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