来氟米特对类风湿关节炎的外周神经的影响观察

目的探讨来氟米特对类风湿关节炎（RA）的周围神经的影响。方法以2012年3月～2013年2月在佛山市第一人民医院接受治疗的26例RA患者为研究对象，随机分为对照组与观察组（n=13）。观察组给予20mg来氟米特连续治疗6个月，对照组给予10mg／d甲氨蝶呤、30mg／（kg·d）的柳氮磺胺吡啶等连续治疗6个月，观察患者临床表现，进行肌电图检查，比较两种药物对周围神经的影响。结果治疗6个月后，观察组13例患者中有5例出现周围神经病变，表现为双手、足麻木、疼痛及双足下垂症状。此外肌电图显示，与对照组相比，观察组正中神经、尺神经、腓总神经运动及感觉神经传导速度均显著减慢，差异有统计学意义（p〈0.05）。结论来氟米特除了具有改善IgA外，还可能有增加周围神经病变的风险，临床应权衡谨慎用药以提高临床疗效。

Objective To investigate the effect of leflunomide on the peripheral nerves in rheumatoid arthritis. Methods From March 2012 to February 2013 in Foshan First People＇s Hospital for treatment of 26 cases of RA patients for the study were randomly divided into control group and observation group, 13 cases in each group. Observation group were given 20 mg of leflunomide treatment of six consecutive months, the control group received 1.0 mg / d methotrexate, 30 mg/（kg·d）of sulfasalazine treatment of six consecutive months, the clinical manifestations observed conduct EMG compare the impact of the two drugs on the surrounding nerves.Results After six-month treatment, five patients in the leflunomide group appeared peripheral neuropathy, as evidenced by hands, elbows numbness, pain and symptom feet drooping. Furthermore, compared with control group, leflunomide significantly dereased the nerve conduction velocity （NCV） of median, ulnar and peroneal nerves （P〈0.05）. Conclusion In addition to improving RA leflunomide, but also may have an increased risk of peripheral neuropathy, clinical medication should weigh carefully in order to improve clinical outcomes.