小剂量甲氨蝶呤治疗幼年型类风湿关节炎的疗效及其急性肝损伤作用  

The efficacy of low-dose methotrexate in the treatment of juvenile rheumatoid arthritisand its acute liver injury effect

作　　者：石倩倩 赵相卓 王颖 王京旭[2] SHI Qianqian;ZHAO Xiangzhuo;WANG Ying;WANG Jingxu(Pharmacy Department,Xingtai People's Hospital,Xingtai 054001,Hebei,China;Rheumatology and Immunization Department,Xingtai People's Hospital,Xingtai 054001,Hebei,China)

机构地区：[1]邢台市人民医院药剂科,河北邢台054001 [2]邢台市人民医院风湿免疫科,河北邢台054001

出　　处：《中南医学科学杂志》2023年第6期920-922,共3页Medical Science Journal of Central South China

基　　金：邢台市重点研发项目(2022ZC120)。

摘　　要：目的探讨小剂量甲氨蝶呤(MTX)治疗幼年型类风湿关节炎(JRA)的疗效及其急性肝损伤作用。方法选择收治的JRA患儿126例,采用随机数字表法分为MTX 5.0组(n=64)和MTX 7.5组(n=62)。两组分别给与5.0、7.5 mg/m^(2)MTX口服,每周1次,均为12周。比较两组临床疗效[美国风湿病学会(ACR)疗效标准ACR30、ACR50、ACR70]、疾病活动度关联指标[红细胞沉降率(ESR)、C反应蛋白(CRP)]和治疗结束后2个月谷丙转氨酶(GPT)、谷草转氨酶(GOP)、碱性磷酸酶(ALP)的变化情况。结果MTX 7.5组ACR30及ACR50均高于MTX 5.0组(P<0.05)。与治疗前相比,两组患儿治疗后ESR、CRP水平均明显降低,且治疗后MTX 7.5组低于MTX 5.0组(均P<0.05);两组治疗结束后2个月GPT、GOP、ALP均高于治疗前(P<0.05)。结论5.0 mg/m^(2)MTX和7.5 mg/m^(2)MTX对肝功能影响轻微且相当,但后者临床疗效更佳,可作为JRA患儿治疗的最佳初始有效剂量。Aim To explore the efficacy of low-dose methotrexate(MTX)in the treatment of juvenile rheumatoid arthritis(JRA)and its relationship with acute liver injury.Methods 126 children with JRA were enrolled,and classified into two groups by random number table methods.MTX 5.0 group(n=64)received oral administration of MTX at the dose of 5.0 mg/m^(2),while MTX 7.5 group(n=62)received oral administration of MTX at the dose of 7.5 mg/m^(2).The treatment was once a week,and lasted for 12 weeks.Then various parameters were compared between two groups,including clinical efficacy[American college of rheumatology(ACR)criteria for 30%improvement(ACR30),(ACR50),(ACR70)],disease activity indexes[erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)]and liver function indicators after 2 months treatment[alanine aminotransferase(GPT),aspartate aminotransferase(GOP),alkaline phosphatase(ALP)].Results The rates of ACR30 and ACR50 in MTX 7.5 group were higher than those in MTX 5.0 group(P<0.05).After treatment,the levels of ESR and CRP in two groups were significantly decreased,and the levels of ESR and CRP in MTX 7.5 group were lower than those in MTX 5.0 group(all P<0.05).2 months after treatment,GPT,GOP and ALP were increased in both groups compared with those before treatment(P<0.05).Conclusion Administration of MTX at the dose of 5.0 mg/m^(2)and 7.5 mg/m^(2)for JRA causes mild and comparable impacts on liver function,but the latter has more favorable clinical effects and serves as the optimal initial effective dose for the treatment of JRA.

关 键 词：幼年型类风湿关节炎 小剂量甲氨蝶呤 疗效 急性肝损伤 

分 类 号：R593.2[医药卫生—内科学]