类风湿关节炎二线药物不良反应回顾性调查

Retrospective study of adverse events in patients with rheumatoid arthritis treated with second-line drugs

目的 比较不同二线药物治疗类风湿关节炎 (RA)不良反应的发生率和撤药率 ,为临床医生选择二线药物提供决策依据。方法 采用回顾性调查方法由经过训练的调查员调查 86 4例RA病人以往服用过的二线药物 ,对这些药物有无不良反应和有何种不良反应。结果 上腹不适为二线药物最常出现的不良反应。甲氨喋呤的胃肠道不良反应 (32 .3% )最多见 ;青霉胺和风痛宁突出表现为皮肤瘙痒性皮疹 (分别为 2 0 .6 %和 13.7% )。青霉胺肾脏损害症状出现危险性明显高于其他药物(是对比危险率的 14 .5倍 )。雷公藤最常见的不良反应是月经周期的紊乱 (14 .4 % )。柳氮磺吡啶主要是上腹不适 (39% )、纳差 (7.3% )、恶心 (7.3% )。眼部不适、视力下降 (19.6 % )是使用氯喹最常见的不适主诉。二线药物不良反应程度是有差别的。不良反应是引起各种二线药物撤药的主要原因 ,甲氨喋呤撤药率最低。甲氨喋呤和青霉胺联用不增加不良反应的发生率和严重程度。结论 熟悉二线药物不良反应 ,有利于临床医师选择药物和治疗方案。注意监测和对症处理不良反应 ,二线药物仍然是安全的。

Objective To evaluate rates on the adverse side effect and discontinuation of second line drugs frequently used in the treatment of rheumatoid arthritis (RA). Method Eight hundred and sixty four RA patients were studied in a retrospective program. Results Upper abdominal discomfort was most commonly seen when using second line drugs. Rash was often associated with D penicillamine ( 20.6 %) and Sinomenium therapy ( 13.7 %). Methotrexate (MTX) was uniquely characterized by substantial upper GI toxicity ( 32.2 %) and Tripterygium wilfordii Hook. f. (TWH) ( 14.4 %) by menstrual abnormality. Sulfasalazine users reported adverse events including upper abdominal trouble ( 39.0 %), nausea ( 7.3 %) and anorexia ( 7.3 %) while the risk of GI malaise was greater. Patients taking hydroxychloroquine complained of blurred vision ( 19.6 %) but no one went blind. Toxic side effects seemed to be the most common reasons for stoppages, and the patients taking MTX had the lowest discontinuation rate. Combination of D penicillamine and Methotrexate did not increase the incidence of adverse events. Conclusions Knowledge on these different patterns of toxicity provided choices in the selection of second line agents for particular RA patients. However, long term monitor are required when drugs are being used. [