血浆置换联合小剂量甲氨蝶呤治疗重症老年类风湿关节炎的疗效观察

Efficacy of plasma exchange combined with low dose of methotrexate in treatment of severe older age rheumatoid arthritis

目的评价血浆置换联合小剂量甲氨蝶呤(MTX)治疗重症老年类风湿关节炎的疗效及安全性。方法入选患者64例,随机分组为试验组34例,对照组30例。试验组进行血浆置换同时口服小剂量MTX及柳氮磺胺吡啶(SSZ);对照组口服同等剂量的MTX及SSZ。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20%及50%、70%改善标准(the American College of Rheumatology20,50,70,ACR20、ACR50、ACR70)进行判断。结果试验组及对照组治疗后第1周达到ACR20分别为32.4%和6.7%(P=0.011);治疗后第12周达到ACR20分别为70.6%和43.3%(P=0.028)、达到ACR50分别为47.0%和23.3%(P=0.030)、达到ACR70分别为26.5%和6.7%(P=0.041);治疗后第24周达到ACR20分别为85.3%和60.0%(P=0.022)、达到ACR50分别为58.8%和33.3%(P=0.041)、达到ACR70分别为35.3%和13.3%(P=0.043)。不良反应试验组6例,对照组4例,对症治疗好转。结论血浆置换联合小剂量MTX治疗重症老年类风湿关节炎疗效明显优于单用小剂量MTX,且起效快、疗效较持久,安全性好。

Objective To assess the efficacy of plasma exchange combined with low dose of methotrexate （MTX） in treatment of severe rheumatoid arthritis in older age patients. Methods Sixty-four older age patients with severe rheumatoid arthritis were enrolled. Thirty-four patients （experimental group） were treated with plasma exchange combined with low dose MTX and sulfasalazine（SSZ）. Another 30 patients （control group） were treated with low dose MTX and SSZ. Patients were assessed at week 1,12,24. Results At week 1, patients having 20% improvement （ACR20） were 32.4% in experimental group and 6.7% in control group（ P =0. 011）; at week 12, patients having ACR20 were 70.6% in experimental group and 43.3% in control group （P = 0.028）, patients having 50% improvement（ACR50） were 47.0 % in experimental group and 23.3 % in control group（ P = 0. 030） ; patients having 70 % improvement（ACR70） were 26.5 % in experimental group and 6.7% in control group（ P = 0. 041）;at week 24, patients having ACR20 were 85.3 % in experimental group and 60.0 % in control group （ P = 0. 022）, patients having ACR50 were 58.8% in experimental group and 33.3% in control group （ P = 0. 041）, patients having ACR70 were 35.3% in experimental group and 13.3% in control group（ P=0. 043）. The occurrence of adverse events were six cases in experimental group and four cases in control group, no serious adverse events occurred. Conclusion Treatment with plasma exchange combined with low dose MTX is more effective than immunosuppressive alone in the older age patients of severe rheumatoid arthritis.