甲氨蝶呤联合依那西普或来氟米特诱导缓解重度类风湿关节炎的疗效比较  

Compare the Efficacy of Amethopterin and Etanercept or Amethopterin and Leflunomide in the Treatment of Rheumatoid Arthritis with Severity Activity

作　　者：岑筱敏[1] 李敏[1] 杨闵[1] 石连杰[1] 叶杨[1] 赵臻怡[1] 钟雪[1] 杨南萍[1] 

机构地区：[1]四川大学华西医院风湿免疫科,四川成都610041

出　　处：《华西医学》2009年第8期2063-2066,共4页West China Medical Journal

摘　　要：目的:探讨甲氨蝶呤联合依那西普(MTX+ETA)和甲氨蝶呤联合来氟米特(MTX+LEF)治疗重度活动的类风湿关节炎(RA)的疗效差异。方法:收集重度活动的RA患者50例。A组24例,给予MTX 10 mg/次,一周一次,口服,联合ETA 25 mg/次,一周2次,皮下注射后病情缓解后依那西普减量为25 mg/次,1周一次至随访结束;B组26例,给予MTX 10 mg一周一次联合来氟米特20 mg/d。两组随访时间为24周。定期随访其红细胞沉降率(ESR)、C反应蛋白(CRP)、DSA28评分、sharp评分、RF、ANA、ACR核心标准评定。结果:①A组在治疗半年前后其VAS评分、晨僵时间、关节肿痛个数、DSA28评分、HAQ、患者评分、医生评价、ESR、CRP方面改善明显,有统计学意义(P<0.05);B组在治疗半年前后其VAS评分、晨僵时间、关节肿痛个数、DSA28评分、HAQ、患者评分、医生评价方面改善明显,有统计学意义(P<0.05);A组和B组在治疗半年后在VAS评分、晨僵时间、关节触痛个数、DSA28评分、HAQ、患者评分、医生评价、ESR、CRP方面改善明显,有统计学意义(P<0.05)。②各组ACR20有效率逐步增加,在各随访期内两组的ACR20的达标率的差异无明显的统计学意义(P>0.05);ACR50则在第4、20、24周,A组的达标率为12%、79%、87%与B组的8%、46%、50%差异有统计学意义(P<0.05);ACR70虽然在各期A组均高于B组,但差异均无差异性(P>0.05)。③A组在第2、4、12周DSA28指数下降明显,跟前次随访指标的差异有统计学意义(P<0.05);B组在第16、24周DSA28指数下降明显,跟前次随访指标的差异有统计学意义(P<0.05);而A组与B组同期DSA28的比较发现,A组从第4周起各期DSA28分值均低于B组,且差异均有统计学意义(P<0.05)④两种治疗方案不良反应发生情况均低,且两组不良事件发生率差异无统计学意义。结论:ETA+MTX和LEF+MTX联合治疗重度活动的RA均是安全有效的,其中前者常常可以更早期的达到诱导缓解病情的目的。Objective：To compare and evaluate the efficacy of amethopterin and etanercept or amethopterin and leflunomide in the treatment of rheumatoid arthritis（RA） with severity activity.Methods：Fifty patients of RA with severity activity were divided into A and B groups;24 patients of Group A accepted amethopterin（MTX） 10 mg once a week orally,and etanercept（ETA） 25 mg twice a week by subcutaneous injectior,when the patient relieved,ETA will be adjusted 25 mg once a week;While 26 patients of Group B accepted amethopterin（MTX） 10 mg once a week orally,and leflunomide（LEF） 20 mg once a day.The course of treatment was 24 weeks.Results：①The significant changes were observed in Group A in visual analog scale,VAS,the time of morning stiffness,the number of joint pain and swelling,the score of DSA28,Health assessment questionnaire,HAQ,the score by patients,the score by doctors,erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）（P〈0.05）;The significant changes were observed in Group B in VAS,the time of morning stiffness,the number of joint pain and swelling,the score of DSA28,HAQ,the score by patients,the score by doctors（P〈0.05）;The significant changes were observed between A and B groups in VAS,the time of morning stiffness,the number of joint pain and swelling,the score of DSA28,HAQ,the score by patients,the score by doctors,ESR,CRP（P〈0.05）.②Both A and B groups achieved nice ACR 20 effective rate during the treatment,but there was no statistical significance（P〉0.05）;In the 4,20,24 weeks,the ACR50 effective rate of Group A were 12%,79%,87%,while Group B were 8%,46%,50%,and group comparison had statistical significance（P〈0.05）;the difference of ACR70 effective rate between A and B groups had no statistical significance（P〉0.05）.③In the 2,4,12 weeks,the significant decreases of the score ofDSA28 were observed in Group A comprised with the last score（P〈0.05）;In the 16,24 weeks,the significant decreases of the score of DSA28 were observed in

关 键 词：类风湿关节炎 肿瘤坏死因子受体 甲氨蝶呤 依那西普 来氟米特 

分 类 号：R593.22[医药卫生—内科学]