目的 探究雷公藤多苷片聯(lián)合依那西普治療類風(fēng)濕性關(guān)節(jié)炎的臨床療效及其對(duì)血清14-3-3η蛋白、抗環(huán)瓜氨酸肽抗體（Anti-CCP）水平的影響。方法 選取2017年12月-2018年12月秦皇島市中醫(yī)醫(yī)院接收的88例類風(fēng)濕關(guān)節(jié)炎患者作為研究對(duì)象，按照治療方法將患者分為對(duì)照組（44例）和觀察組（44例）。對(duì)照組患者皮下注射注射用依那西普，25 mg/次，2次/周。觀察組患者在對(duì)照組治療的基礎(chǔ)上飯后口服雷公藤多苷片，20 mg/次，3次/d。兩組均持續(xù)治療3個(gè)月。觀察兩組患者的臨床療效，同時(shí)比較兩組治療前后的臨床癥狀改善情況、血清腫瘤壞死因子-α（TNF-α）、白細(xì)胞介素-6（IL-6）、白細(xì)胞介素-17（IL-17）、C反應(yīng)蛋白（CRP）、紅細(xì)胞沉降率（ESR）、類風(fēng)濕因子（RF）、14-3-3η蛋白、anti-CCP及免疫指標(biāo)水平。統(tǒng)計(jì)兩組患者的不良反應(yīng)發(fā)生情況和1年復(fù)發(fā)率。結(jié)果 治療后，觀察組總有效率為95.45%，顯著高于對(duì)照組的79.55%，組間比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組晨僵時(shí)間、關(guān)節(jié)壓痛數(shù)、關(guān)節(jié)腫脹數(shù)、VAS評(píng)分均明顯降低（P<0.05）；且治療后，觀察組各臨床癥狀改善程度顯著低于對(duì)照組（P<0.05）。治療后，兩組患者血清TNF-α、IL-6、IL-17、ESR、CRP水平及RF、14-3-3η蛋白、anti-CCP表達(dá)均顯著降低（P<0.05）；且治療后觀察組上述血清學(xué)指標(biāo)均明顯低于對(duì)照組（P<0.05）。治療后，兩組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）水平均顯著降低（P<0.05）；且治療后，觀察組外周血IgA、IgG、IgM水平明顯低于對(duì)照組（P<0.05）。治療期間，兩組不良反應(yīng)發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義。治療結(jié)束后，對(duì)患者隨訪1年，觀察組和對(duì)照組復(fù)發(fā)率分別為4.55%和22.73%；組間比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 雷公藤多苷片聯(lián)合依那西普治療類風(fēng)濕關(guān)節(jié)炎可提高臨床效果，減輕患者臨床癥狀，降低體內(nèi)炎癥指標(biāo)，調(diào)節(jié)機(jī)體免疫，且不易復(fù)發(fā)，值得臨床上推廣應(yīng)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

秦皇島市科學(xué)技術(shù)研究與發(fā)展計(jì)劃項(xiàng)目（201902A006）