摘要
目的观察甲氨蝶呤(MTX)对强直性脊柱炎(AS)髋关节病变的临床疗效,并以柳氮磺吡啶(SSZ)作为对照,以评价MTX对AS髋关节病变的有效性及安全性。方法从住院的AS髋关节病变患者中随机选择MTX治疗的48例为观察组,并以年龄、性别、病程及病情相匹配,采用SSZ治疗的50例作为对照组,两组患者均选择一种非甾体抗炎药作为基础疗法。出院后继续原药物治疗,并随访3年的临床资料,包括临床症状、Bath AS活动指数(BASDAI)、Bath AS功能指数(BASFI)、髋关节功能评分、髋关节病变CT分期、炎性指标等实验室检查及不良反应。结果观察组第1、2、3年随访44、38、32例,对照组分别为45、38、31例。随访3年内,髋关节功能评分观察组显著高于对照组(P<0.05)。髋关节CTⅠ期病变,两组患者随访第2、3年与入院时比较明显减少(P<0.05);随访第2、3年,观察组比对照组显著下降(P<0.05)。髋关节CTⅡ期病变,两组间各时段比较差异均无统计学意义。腰痛、腰背晨僵、BASDAI和BASFI、红细胞沉降率(ESR)、C反应蛋白(CRP),两组间对比差异均无统计学意义。不良反应以胃肠道反应为主,两组比较差异无统计学意义;随访所有病例无造血系统障碍发生。结论MTX对AS髋关节病变的疗效优于SSZ,在治疗3年内髋关节功能明显改善;MTX不良反应较轻,可作为治疗AS髋关节病变的首选药物,其更长期的疗效及安全性有待进一步观察。
Objective To evaluate the efficacy and safety of methotrexate （MTX） on the hip involve ment in patients with ankylosing spondylitis （AS）. Methods Among the AS patients with hip joint involvement admitted to the department from 1999-2002, 50 patients were treated with sulfasalazine （SSZ） （control group, CG） and 48 MTX （observation group, OG）. One kind of NSAIDs was taken by the patients in both groups as the basic therapy. The treatment was maintained in both groups after being discharged. Patients were followed-up for three years. The observation parameters included symptoms, signs, Bath AS disease activity index （BASDAI）, Bath AS functional index （BASFI）, hip joint function score, the CT staging of hip joint involvement, serum inflammation markers, laboratory tests and side effects. The data were analyzed with SPSS10.0 statistics software. Results At the 1st, 2nd and 3rd year, 44, 38 and 32 cases in the OG and 45, 38 and 31 cases in the CG were followed up respectively. During the three-year follow-up period, the hip joint function score of the OG was significantly higher than that of the CG （P〈0.05）. At the 2nd and 3rd year of follow-up, CT change of hip joint at stage I of the two groups was lower than that at admission （P〈0.05）, and it was obviously lower in the OG than in the CG （P〈0.05）. The CT change of hip joint at stage II was similiar between the two groups at each time point. However, in these two groups there was no significant difference in the parameters as low back pain, morning stiffness, BASDAI, BASFI and inflammatory markers. The main side effect was gastrointestinal reaction, but there was no significant difference between the two groups. No aplastic anemia was found in the two groups during the three-year follow-up. Conclusion MTX is better than SSZ in treating hip involvement of AS, which can improve hip joint function during the three-year follow-up. No severe side effect is found in the AS patients treated with MTX. It is suggested that MTX is an effective medication for hip involvement of AS patients.
出处
《中华风湿病学杂志》
CAS
CSCD
2007年第4期213-216,共4页
Chinese Journal of Rheumatology
