甲氨蝶呤联合雷公藤多苷治疗老年类风湿关节炎  

Clinical Observation on Treatment of Rheumatoid Arthritis with Tripterygium Wilfordii Polyglycoside Combined with Methotrexate

作　　者：杨敏[1] 周润华[1] 李宝贞[1] 许佳[1] 石宇红[1] 莫汉有[1] 

机构地区：[1]桂林医学院附属医院风湿免疫科,广西桂林541001

出　　处：《中国实验方剂学杂志》2013年第17期300-304,共5页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金资助项目(81160376)

摘　　要：目的:探讨老年类风湿关节炎(EORA)患者治疗方案,观察甲氨蝶呤联合雷公藤多苷治疗EORA的疗效及不良反应,为临床安全用药提供依据。方法:将80例诊断为EORA的患者,随机分为甲氨蝶呤联合雷公藤多苷治疗组(研究组),单用甲氨蝶呤组(对照组),每组各40例,对照组单用甲氨蝶呤治疗,10 mg/次,1次/周,研究组加服雷公藤多苷,10 mg/次,3次/d,疗程均为6个月。采用美国风湿病学会(ACR)疗效评定标准评定两组疗效,随访观察治疗前后两组临床症状改善、炎症指标改变以及不良反应发生情况。结果:两组在治疗后达到ACR 20%缓解标准差异无统计学意义,而达到ACR 50%缓解标准两组间差异有统计学意义(P<0.05);治疗前后两组各项临床症状、体征及实验室指标比较差异均有统计学意义(P<0.01),治疗6个月后研究组关节肿胀数、ESR、CRP、RF、患者评价及医生评价较对照组均有明显好转,差异均有统计学意义(P<0.01);治疗后研究组不良反应的发生率与对照组比较差异无统计学意义。结论:甲氨蝶呤联合雷公藤多苷治疗EORA安全有效,是治疗EORA较好方案之一。Objective：To explore the treatment of elderly-onset rheumatoid arthritis（EORA）,observe the efficacy and side effects of tripterygium wilfordii polyglycoside combined with methotrexate in treating EORA and provide a reference for clinical safe medication.Method：Eighty patients diagnosed with EORA were randomly divided into tripterygium wilfordii polyglycoside combined with methotrexate group（research group） and methotrexate group（control group）,40 in each group.The control group were treated with methotrexate only,every time 10 mg,once a week for 6 months,while the research group added with tripterygium wilfordii polyglycoside,every time 10 mg,3 times a day for 6 months.Clinical assessment using the American college of rheumatology（ACR） criteria for improvement was performed.A fellow-up observation compared the improvements of clinical symptoms,changes on inflammation markers and the incidences of side effects before treatment with those after treatment.Result：Two groups achieved ACR 20% after treatment which were not significantly different in statistics between two groups;while achieved ACR 50%,there was a significant difference between two groups（P ＆lt; 0.05）;the clinical symptoms,signs and laboratory index of two groups before and after treating were statistically significant difference（P ＆lt; 0.01）.After 6 months treatment,the number of swelled joint,ESR,CRP,RF and the satisfaction of patients and doctor were obviously improved in the research group,and there was statistically significant difference between the two groups（P ＆lt; 0.01）;while the incidence of side effects were not significantly different in statistics with the control group.Conclusion：Tripterygium wilfordii polyglycoside combined with methotrexate is effective and safe in treating EORA cases,which made it become one of the best treatments of EORA.

关 键 词：关节炎 类风湿 老年发病 甲氨蝶呤 雷公藤多苷 

分 类 号：R287[医药卫生—中药学]