目的 探究甲潑尼龍聯(lián)合甲氨蝶呤在治療類風(fēng)濕關(guān)節(jié)炎（RA）中的效果，并對(duì)其作用機(jī)制進(jìn)行探究。方法 選取2014年1月—2017年1月于來(lái)西安市第五醫(yī)院就診120例RA患者，按照隨機(jī)數(shù)字表法分為觀察組和對(duì)照組，各60例。對(duì)照組患者單純使用甲氨蝶呤10 mg/次，1次/周，12周為1療程；觀察組在對(duì)照組基礎(chǔ)上加用甲潑尼龍片，前4周8 mg/次，1次/d，4周逐漸減量改為2 mg/次，1次/d，12周為1療程。治療1周后對(duì)兩組28個(gè)關(guān)節(jié)疾病活動(dòng)度評(píng)分（DAS-28）進(jìn)行對(duì)比，治療12周后對(duì)兩組紅細(xì)胞沉降率（ESR）、C反應(yīng)蛋白（CRP）、類風(fēng)濕因子（RF）進(jìn)行對(duì)比，采用視覺(jué)模擬量表（VAS）對(duì)兩組患者治療前后疼痛度進(jìn)行評(píng)價(jià)。結(jié)果 治療1周后，兩組DAS-28評(píng)分均有下降，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組得分低于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療12周后，兩組ESR、CRP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）；但觀察組ESR較對(duì)照組更慢，CRP含量更少，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。RF檢測(cè)觀察組陽(yáng)性率為41.67%，低于對(duì)照組的58.33%，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；VAS治療前兩組差異無(wú)統(tǒng)計(jì)學(xué)差異，治療后觀察組得分明顯低于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 甲潑尼龍聯(lián)合甲氨蝶呤在治療RA效果顯著，其機(jī)制為甲氨蝶呤能夠抑制體內(nèi)T細(xì)胞的增值，起到一定免疫抑制作用，甲潑尼龍能夠延緩炎癥反應(yīng)對(duì)關(guān)節(jié)的破壞，也能夠降低甲氨蝶呤在使用過(guò)程中的不良反應(yīng)，二者聯(lián)合應(yīng)用效果顯著，值得進(jìn)行臨床推廣。

Objective To investigate the effect of methotrexate (MTX) combined with methylprednisolone in the treatment of rheumatoid arthritis (RA), and to explore its mechanism;Methods From January 2014 to January 2017, 120 patients with RA were randomly divided into experimental group and control group according to the random number table method. The control group was treated with MTX alone. The experimental group received MTX (DAS-28) were compared between the two groups after 12 weeks of treatment. After 12 weeks of treatment, the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) Rheumatoid factor (RF) were compared, the visual analogue scale (VAS) was used to evaluate the pain before and after treatment.Results After 1 week of treatment, the scores of DAS-28 decreased, and the score of the experimental group was lower than that of the control group (P<0.05). After 12 weeks of treatment, the ESR and CRP were significantly decreased (P<0.05). The positive rate of RF test was 41.67% in the experimental group and 58.33% lower than that in the control group. The difference between the two groups before and after VAS treatment was significantly higher than that of the control group (P<0.05), but the difference was statistically significant (P<0.05). The scores of the experimental group were significantly lower than those of the control group (P<0.05). Conclusion TX combined with methylprednisolone in the treatment of RA effect is significant, the mechanism for the MTX can inhibit the value of T cells in the body, play a certain immunosuppressive effect, methylprednisolone can delay the inflammatory response to joint damage, can also reduce the MTX in The use of the process of adverse reactions, the combined effect of the two significant, worthy of clinical promotion.