联合治疗对老年类风湿关节炎患者血脂的影响

Effect of combination therapy on serum lipids in elderly patients with rheumatoid arthritis

目的研究甲氨蝶呤、柳氮磺吡啶、硫酸羟氯喹联合治疗对老年类风湿关节炎患者疾病活动相关指标和血脂的影响。方法老年类风湿关节炎患者随机分为A、B组，每组68例，A组联合应用甲氨蝶呤、柳氮磺吡啶、硫酸羟氯喹治疗并配合一定的生活方式干预，B组则在A组用药基础上加用血脂康。检测两组治疗前和治疗6个月后胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、C-反应蛋白（CRP）和血沉（ESR），以DAS28、关节肿胀指数、关节压痛指数、晨僵时间来评定疾病活动度。结果治疗后两组TC、TG、LDL-C均低于治疗前，HDL-C水平高于治疗前（均P〈O．05）；DAS28、ESR、CRP、关节压痛数、关节肿胀数和晨僵时间较治疗前明显降低（均P〈0．05），治疗后两组间上述指标差异均无统计学意义。两组患者治疗后均未出现明显肝、肾功能损害等不良反应。结论RA患者存在血脂水平异常，慢作用抗风湿药在缓解病情的同时，对于老年患者血脂有一定的影响。

Objective To observe the effect of combination therapy with methotrexate, sulfasalazine and hydroxychloroquine on serum lipids in elderly patients with rheumatoid arthritis （RA）. Methods 136 patients with RA were randomly divided into group A and group B （n=68, each）. Patients in group A were treated with methotrexate, sulfasalazine and hydroxychloroquine sulfate plus life style intervention. Patients in group B were treated with the therapy as same as that of group A and received xuezhikang additionally. The levels of cholesterol （TC）, low density lipoprotein cholesterol （LDL-C）, triglyceride （TG）, high density lipoprotein cholesterol （HDL-C）, C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR） were determined before and 6 months after treatment. Disease activity was assessed by DAS28, swelling index, joint pain index, duration of morning stiffness. Results The levels of TC, TG and LDL-C were lower and HDL-C level was higher in the two groups after 6 months of the treatment than before treatment （all P〈 0.05）. DAS28, ESR, CRP, joint tenderness, joint swelling and duration of morning stiffness were significantly reduced in two groups after 6 months of the treatment as compared with pretreatment （all P〈0.05）. There was no significant difference in levels of TC, TG, LDL-C, HDL-C, DAS28, ESR, CRP, joint tenderness, joint swelling and duration of morning stiffness between the two groups after treatment. There were no obvious differences in liver and kidney function between the two groups before and after treatment. Conclusions Blood lipids levels are abnormal in RA patients. The slow acting antirheumatic drugs have certain effect on blood lipids when alleviating disease symptoms.