甲氨蝶呤治疗早期强直性脊柱炎疗效的初步评价

Preliminary evaluation of the efficacy of methotrexate in treatment of early ankylosing spondylitis

目的 :探讨甲氨蝶呤 (MTX)治疗早期强直性脊柱炎 (AS)的疗效与安全性。方法 :本研究为多中心开放前瞻性研究 ,共入选 2 6例男性门诊患者 ,予MTX每周 7.5mg ,在第 4,8,12 ,16 ,2 0 ,2 4周来诊 ,评价对MTX有反应的主要疗效指标 :晨僵时间、腰痛 10cmVAS、压痛关节数、患者及医师总体感觉VAS ,ESR或CRP水平 ,同时记录Schober试验、髋关节活动范围、扩胸度、枕壁距、指地距以及血尿常规、肝肾功能、免疫球蛋白水平等。结果 :2 6例患者中 2 3例对MTX有反应 ,均无严重不良反应。腰背部晨僵时间从治疗前的 2 3.9min缩短为 5 .4min(P <0 .0 0 0 1) ,平均压痛关节数从治疗前的 1.2 9减少为 0 (P <0 .0 1) ,血沉从治疗前的 47.8mm·h-1降低为 11.9mm·h-1(P <0 .0 0 0 1) ,但NSAIDs应用、疼痛VAS、髋关节活动度、胸腰部活动度、CRP与免疫球蛋白水平均无统计学差异。结论 :小剂量MTX对早期AS患者有较好的疗效 ,且安全性较好 ,但 6个月的MTX治疗尚不能显著改善脊柱与髋关节的活动范围。

Objective:To study the efficacy and safety of methotrexate(MTX) in treatment of early ankylosing spondylitis(AS).Methdos:26 male out patients were enrolled into the multi center,open labeled,prospective study.They were treated with MTX in a regimen of 7.5mg per week since week 2.The following parameters were observed at week 4,8,12,16,20,24:duration of back early morning stiffness (EMS),10cm VAS for back pain,number of tender joints,global assessment of patients and doctors,and ESR/CRP level.The Schober's test,hip range of movement,chest expension,occiput to wall and finger to floor distance,blood routine examination,renal and liver function,and immunoglobulin level were also recorded.Results:23 patients were responsed to MTX treatment and no severe adverse reactions were observed.Significant improvement was observed in EMS[reduced from 23.9 min to 5.4 min( P <0.0001)],the number of tender joints[reduced from 1.29 to 0 ( P < 0.01)], ESR [reduced from 47.8 mm·h -1 to 11.9 mm·h -1 ( P < 0.0001)]. No significant improvement was observed in use of NSAIDs,VAS for pain,hip range of movement,thorathic and lumbar spine movement,CRP and immunoglobulin level.Conclusion:Low dose MTX is safe and useful for suppressing some of the inflammatory features of early AS but further study is needed to evaluate its long term efficacy.