甲氨蝶呤联合云克与维生素D对强直性脊柱炎患者骨代谢水平的影响

Effect of Methotrexate Combined with 99Tc-MDP and Vitamin D in the Treatment of Ankylosing Spondylitis

目的:观察甲氨蝶呤联合云克与维生素D对强直性脊柱炎(AS)患者骨代谢水平的影响。方法:选择60例AS患者,随机均分为2组。对照组应用甲氨蝶呤10～15mg,每周1次;维生素D钙(每片含元素钙300mg,维生素D 100U),qd,每次2片。治疗组在此基础上加用云克(锝[99Tc]亚甲基二膦酸盐),每次10mg,溶于0.9%氯化钠注射液250 mL中静脉滴注,qd,2组均10d为1个疗程。间隔30d后继续下一个疗程,共6个疗程。观察2组患者治疗前后的骨密度(BMD)、外周血骨特异性碱性磷酸酶(BALP)、25-(OH)D3、维生素D受体(VDR)、血沉等指标,并采用AS病情活动指数(BASDAI)评价患者的疗效。结果:疗程结束后,2组患者的BMD正常率均高于治疗前,且治疗组治疗前、后比较和组间比较差异均有统计学意义(P<0.05);治疗后2组患者的BALP、25(-OH)D3、VDR、血沉均显著高于治疗前,2组间比较,除VDR外,其他指标均有统计学意义(P<0.05)。2组不良反应发生率比较差异无统计学意义。结论:在甲氨蝶呤联合维生素D治疗方案基础上加用云克治疗AS疗效较好,副作用小。

OBJECTIVE： To observe the effect of the level of bere metabolism with methotrexate combined with 99Tc-MDP and vitamin D in the treatment of ankylosing spondylitis （AS）. METHODS： 60 AS patients were randomly divided into 2 groups. 2 groups were given methotrexate 10-15 mg weekly, vitamin D calcium （each containing calcium element 300 mg, vitamin D 100 U）, qd, 2 pieces. On this basis, the treatment group was additionally given technetium 99Tc-MDP 10 mg dissolved in 0.9% Sodi- um chloride injection 250 mL via intravenous infusion, qd, for 10 d. Next treatment course continued 30 d after, with a total of 6 courses. The bone mineral density （BMD）, levels of bone-specific alkaline phosphatase （BALP）, 25-（OI-t） D3, vitamin D receptor （VDR）, erythrocyte sedimentation in the peripheral blood and other indicators were observed in 2 groups before and after treat- ment, and the therapeutic efficacy of the patients was evaluated using AS disease activity index （BASDAI）. RESULTS： The nor- mal BMD of patients in 2 groups after treatment were higher than before treatment, and there was statistical significance in the dif- ference between groups or treatment group before and after treatment （P〈0.05） ; the levels of BALP, 25-（OH） D3, VDR, erythro- cyte sedimentation in 2 groups after treatment were significantly higher than before treatment, there was statistical significance in the difference between 2 groups, except VDR （P〈0.05）. There was no serious ADR found in 2 groups. CONCLUSION： On the basis of methotrexate combined with vitamin D therapy, addition of 99Tc-MDP obtain optimal therapeutic efficacy in the treatment of ankylosing spondylitis.