【摘要】目的探索双重血浆置换(double filtration plasmapheresis，DFPP)联合甲氨蝶呤(methotrexate, MTX)治疗类风湿关节炎(rheumatoid arthritis, RA)的疗效。方法2016 年4 月～2017 年5月RA 患者120 例，随机分为对照组和观察组，每组60 例。对照组给予甲氨蝶呤和来氟米特治疗。观察组在对照组治疗基础上给予DFPP。监测2 组患者治疗前后炎症因子、Dickkopf-1(DKK1)、核因子κ-B 受体活化因子配体(nuclear factor κ-B receptor activation factor ligands,RANKL)水平以及关节症状变化，并进行对比分析。结果治疗后2 组患者DKK1 增加(t=4.112，P＜0.001)，RANKL、白细胞介素6、肿瘤坏死因子α、类风湿因子、C 反应蛋白、红细胞沉降率、疼痛关节数和肿胀关节数水平下降，观察组的变化程度大于对照组(t 值分别为2.208，3.926，10.320，35.509，7.233，42.563，9.603，6.056；P 值分别为＜0.001，＜0.001，＜0.001，＜0.001，＜0.001，＜0.001，＜0.001，＜0.001)；观察组患者不良反应总数明显低于对照组(χ2=3.159，P=0.047)。2 组间白细胞、血小板、白蛋白差异无统计学意义(P＞0.05)。结论DFPP 联合MTX治疗促使血清DKK1 升高，降低RANKL 和炎症因子，改善临床症状。

【Abstract】Objective To explore the efficacy of double filtration plasmapheresis (DFPP) combined with methotrexate (MTX) in the treatment of rheumatoid arthritis (RA). Methods A total of 120 RA cases treated during April 2016 to May 2017 were randomly divided into control group (n=60) and observation group (n=60). Patients in control group were treated with MTX and Leflunomide. The levels of inflammatory factors, Dickkopf-1 (DKK1) and nuclear factor κ-B receptor activation factor ligand (RANKL), and joint symptoms were monitored before and after treatment in the two groups. Results After the treatment, DKK1 (t=4.112, P=0.000) increased; RANKL (t=2.208, P=0.000), IL-6 (t=3.926, P=0.000), TNF-α (t=10.320, P=0.000), RF(t= 35.509,  P=0.000), CRP (t=7.233, P=0.000), ESR (t=42.563, P=0.000), number of painful joints (t=9.603, P=0.000) and swollen joints (t=6.056, P=0.000) decreased in the two groups. The degrees of the changes were greater in observation group than in control group (P<0.05). The total number of the adverse reactions was significantly lower in observation group than in control group (c2=3.159, P=0.047). There were no significant differences in WBC, platelet and albumin between the two groups before and after treatment (P＞0.05). Conclusion DFPP combined with MTX treatment increased serum DKK1, reduced RANKL and inflammatory
factors, and improved clinical symptoms.