甲氨蝶呤片联合不同抗风湿药物治疗类风湿关节炎的临床观察

卢向阳+唐芳+陈琳英+兰维娅+李宇+姚血明

【摘 要】目的：比較甲氨蝶呤片（MTX）单用和联合不同抗风湿药物治疗类风湿关节炎的临床疗效和安全性。方法：选取接受MTX单药治疗或MTX联合其他抗风湿药物治疗，且处于活动期的类风湿关节炎患者150例，分别为MTX单药组、MTX + 来氟米特片（LEF）组、MTX + 艾拉莫德片（IMD）组、MTX +沙利度胺片（THD）组、MTX + 硫酸羟氯喹片（HCQ）组，每组30例。5组均予叶酸片口服减轻MTX毒副作用，治疗16周并随访。观察并记录5组患者治疗前后关节肿胀数、关节压痛数、晨僵时间、DAS28评分和类风湿因子（RF）、抗环瓜氨酸肽（CCP）抗体、红细胞沉降率（ESR）、C-反应蛋白（CRP）等实验室指标，同时监测患者肝肾功能、血常规、胃肠道反应等安全性指标。结果：治疗后，5组各项指标较治疗前均改善，联合用药组达ACR20、ACR50、ACR70的比例均高于MTX单药组（P < 0.05），其中MTX + LEF组和MTX + IMD组达ACR20、ACR50、ACR70的比例较高，与MTX + THD组和MTX + HCQ组比较，差异有统计学意义（P < 0.05）。总不良反应发生率为20.00%（30/150），MTX单药组为10.00%（3/30），各联合用药组总的不良反应发生率为22.50%（27/120），MTX + LEF组最高，为36.67%（11/30），MTX + IMD组为20.00%（6/30），MTX + THD组为16.67%（5/30），MTX + HCQ治疗组为16.67%（5/30）。结论：5种方法治疗类风湿关节炎均有较好的疗效，MTX联合LEF或IMD治疗类风湿关节炎的效果更显著；5种方法的不良反应发生率均较低，且有差异，MTX联合LEF稍高。

【关键词】 关节炎，类风湿；甲氨蝶呤片；联合用药；临床观察；抗风湿药物

【ABSTRACT】Objective：To compare the clinical efficacy and safety of methotrexate tablets（MTX）alone or combined with different anti-rheumatic drugs in the treatment of rheumatoid arthritis.Methods：One hundred and fifty cases treated with MTX alone or MTX combined with other anti-rheumatic drugs were divided into a MTX group，a LEF group（MTX + leflunomide tablets），a IMD group（MTX + iguratimod tablets），a THD group（MTX + thalidomide tablets），and a HCQ group（MTX + hydroxychloroquine sulfate tablets），30 cases in each group.All groups were given Folic Acid Tablets orally to reduce the side effects of MTX，treated for sixteen weeks and followed up.Patients in all groups were observed and recorded on the aspects of swollen joint count，joint tenderness count，morning stiffness，DAS28 score，RF，anti-CCP antibody，ESR，and CRP，at the same time monitoring the safety index of their liver and kidney function，routine blood test and gastrointestinal reaction.Results：After the treatment，index of the five groups were improved，and the ratios up to ACR20，ACR50and ACR70 in the combined groups were higher than the MTX group（P < 0.05），among which the ratios up to ACR20，ACR50，ACR70 were higher in the the MTX + LEF group and the MTX + IMD group，and the difference was statistically significant（P > 0.05）compared with the MTX + THD group and the MTX +HCQ group.The total incidence of adverse reactions was 20.00%（30/150），the incidence of adverse reaction in the MTX group was 10.00%（3/30）.The total incidence rate of combined groups was 22.50%（27/120），among which the incidence rate of the MTX + LEF group was the highest[36.67%（11/30）]，the MTX + IMD group was 20.00%（6/30），the MTX + THD group was 16.67%（5/30），and the MTX + HCQ group was 16.67%（5/30）.Conclusion：All the five methods are effective in the treatment of rheumatoid arthritis，among which MTX combined with LEF or IMD is more effective.The incidence of adverse reactions in the five methods is relatively low，and there is a difference between them，with the MTX combined with LEF having the highest incidence of adverse reaction.endprint