小剂量激素治疗类风湿关节炎的研究

Study on Rheumatoid Arthritis Treated with Low Dose of Glucocorticoids

目的:分析糖皮质激素(GCs)治疗类风湿关节炎(RA)的临床效果,并探讨治疗RA的最佳剂量和最佳用药时间,尝试用新的方法对RA的病情及治疗效果进行评价,深化对GCs治疗RA的认识。方法:将50例早期RA患者(病史小于2年)随机分为治疗组和对照组,治疗组使用改变病情抗风湿药物(DMARD)及激素泼尼松10mg/d,对照组给予DMARDs。DMARDs用法为羟基氯喹0.2g每天二次口服,MTX10mg每周一次口服。分别记录治疗前、治疗第6周、12周、24周患者的肿痛关节数、晨僵时间、疼痛指数、急性时相反应物水平及药物相关副作用等临床指标。比较2组患者在不同治疗时间的临床缓解情况,并采用自行设计的药物治疗收益评分方法评价两组患者治疗过程中的受益及由药物副作用造成的损失情况,计算其收益指数。结果:最终44例患者完成实验,治疗组(20例)与对照组(24例)第6周的ACR20的缓解率分别为80.0%、50.0%,2组相比具有统计学意义(p<0.05),第12周的ACR20缓解率分别为90.0%、58.3%(p<0.05),第6周平均收益指数分别为(16.0±8.8)、(10.5±7.1),2组相比具有统计学意义(p<0.05),第12周平均收益指数分别为(24.0±8.0)、(17.0±7.8),2组相比具有统计学意义(p<0.05)。2组第24周ACR20缓解率和平均收益指数比较并无统计学意义。结论:激素对于早期RA患者能较快、明显的改善病情并在短期内取得良好的治疗收益。与单纯使用DMARDs相比,在12周～24周之间联合使用激素的治疗收益优势逐渐减退。

Objective：To analyze the effects of glucocorticoids（GCs） treatment on patients with rheumatoid arthritis（RA）,and to discuss the best time and dose.Use a new methods to analyze the effects of treatment and situation and to improve the understanding of treatment for RA with GCs.Methods：50 Patients with RA of2 years＇duration were randomly assigned in a double-blinded manner to receive GCs（prednisone 10 mg/d）or placebo while starting concomitanmt DMARD therapy（hydroxychloroquine 0.2g bid po and MTX 10mg qw po）.The number of pain and swollen joints,the time of morning stiffness,pain score and side effects were taken 6,12,24 weeks.Compare the degree of releasation between two groups at different time,and use a persnely desine method to analyze the gains and lose made by medicines,calculate the score of it.Result：44 Patients completed the study（20 patients treated with GC and DMARDs while 24 treated with DMARDs only）.The ACR20 of treated group and control group at the 6th week were 80.0%、50.0%,Compared with the two groups was significan（tp0.05）,and the 12th week 90.0%、58.3%（p0.05）.The score of treatment gains at the 6th week were（16.0±8.8）、（10.5±7.1）,Compared with the two groups was significant（p0.05）,and the 12th week（24.0±8.0）、 （17.0±7.8）,Compared with the two groups was significant（p0.05）。The two results of 24th week were no statistics significance.Conclusion：For the patients with active RA of2 years duration,low dose of GCs can provide a fast and high remission rate,and also a good traetment gained score.Between the 12th and the 24th week,compare with treated only DMARDs,and combined with GCs,superiority of later will gradually vanish.