不同剂量糖皮质激素对早期类风湿关节炎患者疗效及不良反应分析

The analysis on efficacy and adverse reactions of early rheumatoid patients treated by different doses of glucocorticoids

目的探讨糖皮质激素对早期类风湿关节炎患者的疗效及其不良反应。方法回顾性分析73例早期类风湿关节炎患者的临床资料并进行随访,将其按激素用量分为中等剂量组、小剂量组和对照组。结果①中等剂量组患者的关节疼痛、肿胀的缓解,ESR、CRP及DAS28评分的减低明显优于其他组(P<0.05);②尚不能认为3组患者的RF随时间变化的趋势不同(P>0.05);③3组患者达到ACR20标准的比率无统计学差异(P>0.05);中等剂量组达到ACR70标准的比率高于其他组(P<0.05);④中等剂量组患者体质量增加比率高于其他组,出现胃肠道不适的发生率低于其他组(P均<0.05);⑤3组患者出现血压、血糖升高的发生率相近(P>0.05)。结论①短期应用中等剂量糖皮质激素可以迅速缓解患者的临床症状;②治疗过程中无明显副作用,安全有效。

Objective To investigate the efficacy and adverse reactions of glucocorticoids treatment on the early rheumatoid arthritis patients. Methods Seventy three patients who were in accord with the standard of early rheumatoid arthritis were retrospectively analysed and followed - up studied, and they were divided into three groups according to the amount of glucoeorticoids treatment： medium - dose group, low - dose group and the control group. Results （~）The ease of joint tenderness, joint swelling and the decrease of ESR, CRP and DAS28 score in the medium - dose group were better than those in the other two groups （ P 〈 0.05 ）. （~）The RF trends over time in three groups could not be considered different （ P 〉 0.05 ）. （3）The rate to reaching the standard of ACR20 of three groups showed no statistical difference （ P 〉 0.05 ）, and the ratio of medium - dose group to achieve the standard of ACR70 was better than that of the other two groups （ P 〈 0.05 ）. （4）The rate of weight gain in the medium - dose group is higher than that of the other two groups, the incidence of gastrointestinal discomfort in medium - dose group is least of all （ all P 〈 0.05 ）. （5）Some patients showed rising blood pressure and blood sugar, but the incidence was not statistically significant （ P 〉 0.05 ）. Conclusion （1） The clinical symptoms can be relieved quickly in early rheumatoid arthritis patients treated by moderate doses of glucocortieoids in the short - term. （2）The course of treatment does not bring many side effects, and the use of glucocortieoids in patients is safe and effective.