类风湿关节炎经雷公藤联合甲氨蝶呤治疗达临床缓解后复发的风险因素分析  

The analysis of risk factors for relapse of rheumatoid arthritis after clinical remission after tripterygium wilfordii combined with methotrexate

作　　者：鲁科峰[1] 汤靖岚[1] 王丽娟[1] 朱立松[1] 侯春杰[1] 杜佩[1] 陈聪宪 刘莹 张帆[1] Lu Kefeng

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)

出　　处：《浙江临床医学》2023年第2期176-178,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省中医药科技计划项目(2019ZA012,2019ZA013);浙江省医药卫生科技计划项目(2019KY023,2016KYB019)。

摘　　要：目的 分析雷公藤多苷片联合甲氨蝶呤治疗后达到临床缓解的类风湿关节炎患者复发风险因素.方法 选择雷公藤多苷片联合甲氨蝶呤治疗后达到临床缓解的RA患者56例,临床缓解判定标准为28关节疾病活动度评分(DAS28)≤2.6,且持续时间≥6个月.根据1年随访期限内的持续缓解情况,将所有患者分为持续缓解组和复发组,分析RA患者经雷公藤联合甲氨蝶呤治疗临床缓解后复发的独立风险因素.结果 纳入56例RA患者中,复发18例,单因素分析显示肿胀关节数、ESR、基线DAS28评分、ACPA阳性率及血流滑膜炎评分是RA复发的风险因素,Logistic回归分析显示基线DAS28评分以及血流滑膜炎评分是RA临床缓解后复发的独立风险因素,ROC曲线下面积分别为0.783和0.798,预测临界值为基线DAS28评分1.9分(敏感度85%,特异度61.1%),血流滑膜炎评分1分(敏感度73.7%,特异度75.7%).结论 肌骨超声联合临床疾病活动度对RA患者经雷公藤多苷片联合甲氨蝶呤治疗达到临床缓解后复发具有一定的预测价值.Objective To investigate the risk factors for relapse in patients with rheumatoid arthritis(RA)who were treated with tripterygium wifordi polyglycoside tablets combined with methotrexate after clinical remission.Methods56 RA patients who achieved clinical remission after treatment with tripterygium wilfordi polyglycoside tablets combined with methotrexate were included into this study.The criteria for clinical remission was the disease activity score in 28 joints(DAS28)≤2.6 for at least 6 months.Based on whether remained in remission during the one-year follow-up period,ll participants were divided into continuous remission group and relapse group.Musculoskeletal ultrasound score,general clinical data and serological test indexes were compared between the two groups at baseline to explore the risk factors for relapse after clinical remission.Results 18 cases(32.14%)had recurrence.Univariate analysis showed that the number of swollen joints,ESR,DAS28 score,ACPA positive rate and blood flow synovitis score were correlated with RA recurrence.Logistic regression analysis showed that DAS28 score and blood flow synovitis score were the independent risk factors for RA recurrence after clinical remission.The area under operating characteristic curve(ROC)curve was 0.783 and 0.798,respectively,and the predictive critical value was DAS28 score 1.9 points(sensitivity 85%,specificity 61.1%),blood flow synovitis score 1(sensitivity 73.7%,specificity 75.7%).Conclusion Musculoskeletal ultrasound combined with clinical disease activity has certain predictive value for the recurrence of RA patients treated with tripterygium wilfordii polyglycoside tablets combined with methotrexate after clinical remission.

关 键 词：类风湿关节炎 雷公藤 临床缓解 复发 肌骨超声 

分 类 号：R593.22[医药卫生—内科学]