甲氨蝶呤在国人类风湿关节炎治疗中不良反应的调查及分析  

The investigation and analysis of the adverse effects of methotrexate in the treatment of rheumatoid arthritis

作　　者：于萍[1] 任立敏[2] 王秀茹[2] 刘栩[2] 崔刘福[1] 栗占国[2] 

机构地区：[1]华北煤炭医学院附属开滦医院风湿免疫科,唐山063000 [2]北京大学人民医院风湿免疫科

出　　处：《中华风湿病学杂志》2010年第8期550-553,共4页Chinese Journal of Rheumatology

基　　金：“十一五”国家科技支撑计划（2008BAI59B01）

摘　　要：目的调查类风湿关节炎（RA）患者治疗中服用甲氨蝶呤（MTX）及其不良反应发生情况。方法以现场问卷调查的形式记录325例RA患者服用MTX及其相关不良反应。采用SPSS11．5软件进行统计分析。率的比较采用Х^2检验。结果①服用MTX患者总不良反应发生111例，占34．2％，其中胃肠道反应发生率最高（64例，占19．7％）。总停药43例，占13．2％，其中肝功能损害停药率最高（17例，占5．2％）。胃肠道反应及口腔溃疡发生时间在1周之内，肝功能受损、白细胞减少一般1-2个月。②MTX不良反应的发生率随服用剂量的增加而升高。③服用叶酸组不良反应发生率均低于未服叶酸组。结论MTX治疗RA不良反应较常见，程度较轻，但应定期随访，避免严重不良反应的发生。补充叶酸可明显增加患者的耐受性。Objective To investigate and analyze the adverse effect（AE） of methotrexate （MTX） in rheumatoid arthritis （RA）. Methods Three hundred and twenty-five RA patients were investigated with a questionnaire in clinical service of department of Rheumatology and Immunology, Peking University People＇s Hospital. SPSS 11.5 software was used for statistical analysis. Results （1） The total prevalence of AE was 34.2%. Among these, gastrointestinal AE were the most common, others included elevated liver enzymes, leucocytopenia,alopecia and dental ulcer. The incidence of drug withdrawal of MTX was 13.2%, elevated liver enzymes was the most common reason of withdrawal, other reasons were gastrointestinal AE, leucocytopenia, dental ulcer and alopecia. The gastrointestinal AE and dental ulcer occurred within one week after initiating the medication in average, while elevated liver enzymes and leucocytopenia usually occurred at about 1-2 months after the medication. （2） The incidence of AE increased with the dosage. （3） Folic acid could significantly decrease the total incidence of AE （P〈0.05）. The incidence of gastrointestinal AE, elevated liver enzymes,leucocytopenia and dental ulcer could be reduced by folic acid supplementation （P〈0.05）. Conclusion The AE of MTX in RA treatment are common, many of which are slight and could be improved by reducing the dosage or symptomatic treatment. The AEs of MTX can be improved by folic acid supplement treatment.

关 键 词：甲氨蝶呤 关节炎 类风湿 叶酸 不良反应 

分 类 号：R593.22[医药卫生—内科学]