糖皮质激素治疗对抑制类风湿关节炎软骨破坏的短期疗效观察

A Short-Term Trial of Steroid Treatment in Patients with Active Rheumatoid Arthritis

目的 检测血清软骨寡聚基质蛋白（COMP）水平在糖皮质激素治疗类风湿关节炎（RA）的前后变化以评价糖皮质激素在抑制RA软骨破坏中的意义.方法 收集急性活动期RA患者59例（未接受过糖皮质激素治疗,无内脏受累）,随机分为激素治疗组和非激素治疗组,两组均以慢作用抗风湿药物为基础用药,分别予治疗前、治疗后1周、2周及4周时记录COMP、血沉（ESR）、C反应蛋白（CRP）等指标,评估DAS28评分、ACR70等并进行比较.另取18例正常对照组,检测血清COMP水平.结果 RA患者COMP水平较正常对照组高,激素治疗组COMP水平下降较未用激素组明显,差异具有统计学意义.结论 COMP可作为关节软骨破坏的生物学标记物,并可用于RA的疗效评估.联合应用小剂量激素可迅速、明显地缓解RA的关节症状,降低血清COMP水平,推断其可缓解软骨破坏进展.

Objective To detect the serum level of cartilage oligomeric matrix protein（COMP） in patients with rheumatoid arthritis（RA） undergoing steroid treatment in order to evaluate the significance of steroid treatment in RA. Methods Fifty-nine adult patients with active RA were randomly divided into the study group and the control group. Both the two groups were treated with disease-modifying antirheumatic drugs（ DMARDs）. Eighteen healthy people were chosen as the control group and serum level of COMP was measured. Simultaneously,the levels of erythrocyte sedimentation rate（ ESR）, C-reactive protein（ CRP）, DAS28 and ACR70 were measured in RA group 0,1,2 and 4 weeks atter the treatment. Finally,the above mentioned parameters were analysed. Results Compared with the control group,the serum level of COMP elevated in the RA group,and the serum COMP level of patients undergoing steroid treatment decreased significantly within 4 weeks. Conclusion COMP seems not only to be as a valuable parameter of cartilage deg-radation,but also as a marker for monitoring the therapy response in patients with RA. The treatment with steroids in pa-tients with highly active RA leads to a significant decrease of COMP level and has a rapid chondro-protective effect.