甲氨蝶呤在类风湿关节炎患者中的应用现状  

Application status of methotrexate in patients with rheumatoid arthritis

作　　者：韩艺钧 陈小莉 李常虹[1] 赵金霞[1] HAN Yijun;CHEN Xiaoli;LI Changhong;ZHAO Jinxia(Department of Rheumatology and Immunology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院风湿免疫科,北京100191

出　　处：《北京大学学报（医学版）》2024年第6期994-1000,共7页Journal of Peking University:Health Sciences

基　　金：北京大学第三医院临床队列建设项目(BYSYDL2022017)。

摘　　要：目的:分析甲氨蝶呤(methotrexate,MTX)在类风湿关节炎(rheumatoid arthritis,RA)患者中的应用现状。方法:纳入2022年1月1日至2023年11月31日于北京大学第三医院风湿免疫科诊治的RA患者,调查MTX的应用情况,包括起始剂量、最大剂量、目前用药情况、停药原因等,收集患者的临床信息和实验室数据,分析MTX应用与疾病控制情况之间的相关性。采用t检验、Mann-Whitney秩和检验、卡方检验和Fisher确切概率法和多因素回归分析进行统计学分析。结果:共纳入RA患者239例,其中女性201例,男性38例,平均年龄(54.5±14.3)岁。239例患者中,治疗达标(临床缓解或低疾病活动度)患者101例(42.2%),符合欧洲抗风湿病联盟(European League Against Rheumatism,EULAR)定义的难治性RA患者26例(10.9%),曾应用MTX的比例为84.1%(201/239例),而目前仍规律应用者仅为39.7%(95/239例),且应用MTX的剂量普遍偏低,起始剂量为每周(9.5±3.0)mg,最大剂量中位数为每周15.0(10.0,15.0)mg,目前剂量为每周(12.4±2.7)mg。最常见的停药或减量原因为不良反应,主要包括肝功能异常、胃肠道不适及白细胞减少。目前规律应用MTX者与未用药者相比,治疗达标率更高(52.6%vs.35.4%,P>0.05)、疾病活动度更低[28个关节计数的疾病活动评分(28-joint disease activity score,DAS28)-红细胞沉降率(erythrocyte sedimentation rate,ESR)评分(3.6±1.8)分vs.(4.2±1.8)分,P<0.05]、疼痛关节数更少[(4.8±8.3)个vs.(8.6±10.4)个,P<0.05];而肿胀关节数、患者疼痛评分及总体评分、C反应蛋白、ESR等指标两组差异无统计学意义。与治疗未达标者相比,治疗达标者规律应用MTX的比例较高(48.5%vs.33.3%,P<0.05),既往应用MTX的比例相当(84.2%vs.84.1%,P>0.05);治疗达标者应用MTX的最大剂量较大(中位数每周15.0 mg vs.13.7 mg,P>0.05),目前剂量也较大[每周(12.9±2.5)mg vs.(11.8±2.8)mg,P>0.05],而起始剂量两组相当[每周(9.6±2.8)mg vs.(9.5±3.1)mg,P>0.05]。�Objective:To investigate the current status of methotrexate(MTX)application in rheumatoid arthritis(RA)patients.Methods:The clinical and laboratory data of RA patients who attended in the Department of Rheumatology and Immunology of Peking University Third Hospital from January 1,2022 to November 31,2023 were collected retrospectively.In order to figure out the relationship between MTX use and RA disease control,we recorded information including the starting dose,maximum dose,current dose,reasons of discontinuation of MTX,etc.The t test,Mann-Whitney U test,Chi-square test,Fisher’s exact probability and multivariable Logistic regression were used for analysis.Results:A total of 239 RA patients were enrolled,including 201 females and 38 males with a mean age of(54.5±14.3)years.Among them,101 patients reached the therapeutic target[clinical remission or low disease activity assessed by 28-joint disease activity score(DAS28)-erythrocyte sedimentation rate(ESR)],accounting for 42.2%of the RA patients.Twenty-six patients met the European League Against Rheumatism(EULAR)definition of difficult-to-treat(D2T)RA,accounting for 10.9%of RA patients.The proportion of the RA patients who had ever used MTX was 84.1%,and those who were currently on it accounted for only 39.7%.The MTX dose was generally low,with a starting dose of(9.5±3.0)mg/week,the maximum dose of 15.0(10.0,15.0)mg/week,and the current dose being(12.4±2.7)mg/week.The most common reasons for MTX dose reduction or discontinuation were adverse reactions,mainly including abnormalities of hepatic function,gastrointestinal discomfort,leucopenia,etc.Those who were currently on MTX had a higher rate of treatment to target(52.6%vs.35.4%,P>0.05),lower disease activity score(DAS28-ESR,3.6±1.8 vs.4.2±1.8,P<0.05),and fewer tender joint counts(4.8±8.3 vs.8.6±10.4,P<0.05)as compared with those who were not taking the drug,while swollen joint count,pain visual analog score and patient’s global score,C-reactive protein(CRP)level and ESR level were not significantly d

关 键 词：类风湿关节炎 甲氨蝶呤 剂量效应关系 药物 达标治疗 

分 类 号：R593.22[医药卫生—内科学]