血浆置换联合甲氨蝶呤、柳氮磺胺吡啶治疗重症类风湿关节炎30例

The efficacy of plasma exchange combined with methotrexate and sulfasalazine in the treatment of severe rheumatoid arthritis

目的:评价血浆置换联合甲氨蝶呤(MTX)、柳氮磺胺吡啶(SSZ)与单纯甲氨蝶呤、柳氮磺胺吡啶治疗重症类风湿关节炎的疗效与安全性。方法:本研究采用随机对照方法,入选患者71例,随机分组,试验组32例,对照组39例。试验组血浆置换同时口服甲氨蝶呤及柳氮磺胺吡啶;对照组口服同等剂量的甲氨蝶呤及柳氮磺胺吡啶。试验组及对照组均在治疗后第1、12、24周评价疗效。疗效评价采用美国风湿病学会(ACR)疗效评价指标ACR20、ACR50、ACR70。结果:试验组及对照组治疗后第1周达到ACR20分别为34%和7.7%;治疗后第12周达到ACR20分别为75%和51%、达到ACR50分别为47%和26%;治疗后第24周达到ACR20分别为90%和74%、达到ACR50分别为62%和36%、达到ACR70分别为30%和10%。试验组及对照组出现不良反应共9例,对症治疗好转。结论:血浆置换联合甲氨蝶呤、柳氮磺胺吡啶治疗重症RA疗效显著,明显优于单纯甲氨蝶呤、柳氮磺胺吡啶,且起效快、副作用小,安全性好。

Objective： To assess the clinical efficacy and safety of plasma exchange combined with methotrexate （MTX）and sulfasalazine（SSZ） in the treatment of severe rheumatoid arthritis （RA）. Methods：71 patients with severe RA were enrolled. 32 patients（experimental groups） were treated with plasma exchange combined with MTX and SSZ; Other 39 patients （reference groups） were treated with MTX and SSZ. Patients were assessed at weeks 1,12,24. Results：Patients had 20 percent or 50 percent or 70 percent improvement （ACR core set：ACR20. ACR50. ACR70）, at 1-week（ACR20 experimental groups 34% vs reference groups 7. 7%）; at 12-week （ACR20 experimental groups75% vs reference groups 51%）, ACR50 experimental groups 47% vs reference groups 26%; at 24-week （ACR20 experimental groups 90% vs reference groups 74%）, （ACR50 experimental groups 62% vs reference groups 36%）, ACR70 experimental groups 30% vs reference groups 10%. Conclusion： Treatment with plasma exchange combined with MTX and SSZ is more effective than MTX and SSZ alone in the Patients of severe rheumatoid arthritis. It has rapid effect and the efficacy is persistent.