类风湿关节炎二线药物用药决策分析

Selection of second-line drugs in rheumatoid arthritis

目的 通过回顾性研究比较不同二线药物治疗类风湿关节炎（ＲＡ）的副反应发生率和撤药率，为临床医生选择二线药物提供决策依据。方法 由经过训练的调查员调查８６４例ＲＡ病人以往服用过的二线药物，这些药物有无副反应和有何种副反应。结果 上腹不适为二线药物最常出现的副反应；甲氨蝶呤胃肠道副反应（发生率为 １４３．１／１ ０００人年）最多见；青霉胺和风痛宁突出表现为皮肤出现瘙痒性皮疹（分别为８４．４和８７．７／１ ０００人年）。雷公藤多甙最常见的副反应是月经周期的紊乱（５４．１／１ ０００人年）。柳氮磺吡啶主要是胃肠道症状（上腹不适 １１８．９／１０００人年，纳差５９．４／１ ０００人年）。眼部不适、视力下降（１５７．６／１ ０００人年）是使用氯喹最常见的不适主诉。二线药物副反应程度是有差别的。药物副反应是引起各种二线药物撤药的主要原因，甲氨蝶呤撤药率最低。甲氨蝶呤和雷公藤多甙、风痛宁和青霉胺有相似的副反应模式。结论 熟悉二线药物副反应，有利于临床医师选择药物和治疗方案。注意监测和对症处理副反应，二线药物仍然是安全的。

Objective To evaluate the adverse effect rate and withdrawal rate for second-line drugs frequently used in the treatment of rheumatoid arthritis (RA) . Methods Eight hundred and sixty-four RA patients had been investigated in the retrospective study. Results Upper abdominal trouble was mostly associated with second-line drugs usage. Rash was the most common toxic event with D-penicillamine (incidence 84.4/1 000 persons year) and sinomenium therapy (87.7/1 000 persons year). Methotrexate (MTX) was uniquely characterized by gastrointestinal toxicity (143.12/1 000 persons year) and tripterygium glycosides (TG) (54. 196) by menstrual abnormality. Sulfasalazine users complained of the upper abdominal trouble (118.9/1 000 persons year) and anorexia (59.4/1 000 persons year). Patients taking hydxoxy-chloroquine complained of blurred vision (157.6/1 000 persons year) but no one went blind. Discontinuation was usually attributed to toxic events and the patients taking MTX had the lowest withdrawal rate. D-penicillamine and sinomenium had a closely similar pattern of toxicity, as did TG and MTX. Conclusion Knowing well the different toxicity patterns enables more appropriate selection of second-line agents for particular RA patients. It is necessary for us to routinely monitor and symptomatically treat any adverse reactions occurred.