多聚谷氨酸化甲氨蝶呤浓度与类风湿关节炎疗效相关性研究  

Correlation of methotrexate polyglutamate concentration in erythrocyte with methotrexate efficacy in rheumatoid arthritis patients

作　　者：罗彦[1] 王志中[1] 王勇[1] 牟方祥[1] 吴红[1] 方勇飞[1] 万萍[1] 

机构地区：[1]第三军医大学西南医院中西医结合科,重庆400038

出　　处：《第三军医大学学报》2011年第5期473-476,共4页Journal of Third Military Medical University

基　　金：第三军医大学西南医院院管课题(SWH2006B008)~~

摘　　要：目的探讨经甲氨蝶呤(methotrexate,MTX)治疗的类风湿关节炎(rheumatoid arthritis,RA)患者红细胞内多聚谷氨酸化甲氨蝶呤(methotrexate polyglutamate,MTXPG)的浓度与其疾病活动度的关系。方法选取76例经MTX治疗3个月的RA患者进行横断面研究,采用ELISA方法检测红细胞内MTXPG浓度,根据治疗后疾病活动度(DAS28)以及治疗前后DAS28差异性分值分为显效、有效和无效组,进行各组之间MTXPG浓度的比较及相关性分析。结果经MTX治疗后21例RA患者显效,41例有效,14例无效。显效组红细胞内MTXPG浓度为(158.87±48.27)ng/ml,显著高于有效组(105.89±24.23)ng/ml及无效组(85.80±21.30)ng/ml(P<0.01)。红细胞内MXPG浓度与CRP(r=-0.628,P=0.000)、晨僵时间(r=-0.396,P=0.000)、肿胀关节数(r=-0.321,P=0.005)、压痛关节数(r=-0.376,P=0.001)、视觉模拟评分(VAS)(r=-0.236,P=0.000)、DAS(r=-0.255,P=0.026)呈显著负相关;与血沉、健康问卷评分(HAQ)无相关性(P>0.05)。结论经MTX治疗的RA患者各疗效组间红细胞内MTXPG浓度差异显著,较高浓度的MTXPG与较好的临床疗效相关。Objective To investigate the correlation between the disease activity and methotrexate polyglutamate（MTXPG） concentration in the erythrocytes of rheumatoid arthritis（RA） patients treated with methotrexate（MTX）.Methods Seventy-six cases of RA patients,treated with MTX for 3 months,were selected for the cross-sectional study.MTXPG concentrations in the erythrocytes of RA patients were measured by ELISA.The seventy-six cases were divided into a remarkably effective group,an effective group and an ineffective group based on disease activity score（DAS28） after treatment as well as DAS28 difference before and after treatment.MTXPG concentrations were compared among the above groups,and their correlation with MTX efficacy on RA was analyzed.Results The numbers of RA patients in the remarkably effective group,effective group and ineffective group were 21,41 and 14,respectively.MTXPG concentrations in the erythrocytes of the remarkably effective group were 158.87±48.27 ng/ml,significantly higher than those of the effective group（105.89±24.23 ng/ml） and ineffective group（85.80±21.30 ng/ml）（P0.01）.MTXPG concentrations were negatively related to CRP（r=-0.628,P=0.000）,time of morning stiffness（r=-0.396,P=0.000）,swollen joint count（r=-0.321,P=0.005）,tender joint count（r=-0.376,P=0.001）,visual analogue scale（r=-0.236,P=0.000）,and DAS（r=-0.255,P=0.026）.However,there was no correlation between MTXPG concentrations and blood sedimentation or health assessment questionnaire（P0.05）.Conclusion MTXPG concentrations in the erythrocytes are significantly different in the remarkably effective group,effective group and ineffective group of RA patients treated with MTX.The higher the MTXPG level,the better the clinical efficacy.

关 键 词：类风湿关节炎 甲氨蝶呤 多聚谷氨酸化甲氨蝶呤 

分 类 号：R593.22[医药卫生—内科学] R969.4[医药卫生—临床医学]