摘要
目的探讨甲氨蝶呤(Methotrexate,MTX)单用或联合雷公藤多苷片对老年类风湿关节炎(RA)患者临床疗效及随访安全性的影响。方法选择2014年5月—2018年4月期间就诊的113例老年RA患者作为研究对象,包括45例老年发病的类风湿性关节炎(Elderly onset rheumatoidarthritis,EORA)患者和68例发病年龄小于60岁但当前年龄≥60岁的RA患者(Non-Elderly onset rheumatoid arthritis,NEORA)。将EORA患者和NEORA患者随机分为MTX单药治疗组(单药组)和联合雷公藤多苷片治疗组(联合组)。单药组单用MTX治疗,10 mg/次,1次/周,联合组加服雷公藤多苷片,20 mg/次,3次/d,治疗6个月,随访观察治疗前后各组临床症状改善、炎症指标改变以及不良反应发生情况。结果EORA患者起病年龄大于NEORA组患者,且女性患者比例、当前吸烟患者比例、大关节起病比例较高(P<0.05)。治疗后,单药-EORA亚组、单药-NEORA亚组、联合-EORA亚组、联合NEORA亚组患者类风湿因子滴度、抗环瓜氨酸肽抗体滴度、血沉、C反应蛋白均值以及临床病情活动指数低于同组治疗前(P<0.05)。而且联合组2亚组患者上述指标较单药组患者改善更显著(P<0.05);但是联合-EORA亚组和联合NEORA亚组相比,差异无统计学意义(P>0.05)。而单药-EORA亚组患者上述指标较单药-NEORA亚组降低更明显(P<0.05)。另外,只有联合-EORA亚组患者血清IgG、IgA、C4指标较治疗前有所降低(P<0.05)。治疗和随访期间4个亚组不良反应的发生率比较差异无统计学意义(P>0.05)。结论小剂量MTX单用或联合雷公藤多苷片都可以改善老年RA患者的临床症状,降低炎性指标,而联合用药临床疗效更明显,且不增加药物毒副作用,尤其对于NEORA患者其疗效优于单药治疗。
Objective To investigate the clinical effect and followed-up safety of methotrexate(MTX)combined with Tripterygium Glycosides Tablets in treating elderly rheumatoid arthritis(RA).Methods 113 elderly RA patients admitted from May 2014 to April 2018 were included into the study,including 45 patients with elderly onset rheumatoid arthritis(EORA)and 68 patients with non-elderly onset rheumatoid arthritis(onset age<60 and current age≥60)(NEORA).They were randomly divided into the MTX group(treated by MTX only)and the combination group(treated by MTX combined with Tripterygium Glycosides Tablets).The MTX group were given methotrexate only,10 mg each time,once a week for 6 months.The combination group were additionally given Tripterygium Glycosides Tablets,20 mg each time,3 times per day for 6 months.Improvement of clinical symptoms,inflammatory marks,adverse reactions were compared before and after treatment.Results Onset age,ratio of females,smokers and large joint onset in the EORA group were significantly higher than those in the NEORA group(P<0.05).After treatment,rheumatoid factor(RF),Anti-CCP,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)values and CDAI scores of patients in the MTX-EORA subgroup,MTX-NEORA subgroup,combination-EORA subgroup,combination-NEORA subgroup decreased than those before treatment(P<0.05).The improvement of the above indexes in the combination group was more significant than MTX group(P<0.05).Besides,there was no statistical difference between EORA patients and NEORA patients in the combination group(P>0.05).But EORA patients in MTX group had lower indexes than NEORA patients in MTX group(P<0.05).IgG,IgA and C4 indexes in EORA patients of the combination group decreased(P<0.05).There was no significant difference of adverse reactions in four subgroups during the treatment and in the follow-up period(P>0.05).Conclusion[KG1]A small amount of MTX or combination of Tripterygium Glycosides Tablets with MTX is effective in improving symptoms of elderly RA patients and reduce inflammatory markers.However,combination application has more significant effect without extra adverse reactions.It′s more effective for NEORA patients than single medicine treatment.
作者
朱琳
陈鹏
邹荥
杜红莲
周云
顾向浩
孙玄静
王蕾
ZHU Lin;CHEN Peng;ZOU Xing;DU Hong-lian;ZHOU Yun;GU Xiang-hao;SUN Xuan-jing;WANG Lei(Xuzhou Hospital of Traditional Chinese Medicine,The Affiliated Hospital of Nanjing University of Chinese Medicine,Xuzhou Jiangsu 221000)
出处
《世界中西医结合杂志》
2020年第2期339-343,347,共6页
World Journal of Integrated Traditional and Western Medicine
关键词
类风湿关节炎
老年发病
甲氨蝶呤
雷公藤多苷片
不良反应
rheumatoid arthritis
elderly onset
methotrexate
Tripterygium Glycosides Tablets
adverse reactions
