大剂量糖皮质激素对早期活动性类风湿关节炎的疗效观察

Clinical study of high-dose glucocorticoid on early active rheumatoid arthritis

目的 探讨大剂量糖皮质激素对早期活动性类风湿关节炎患者的疗效及不良反应.方法 将早期活动性类风湿关节炎患者按治疗方法分为三组：大剂量组（16例,采用大剂量糖皮质激素治疗）、小剂量组（17例,采用小剂量糖皮质激素治疗）和对照组（41例,不采用糖皮质激素治疗）.比较三组的治疗效果及不良反应.结果 大剂量组治疗后1周关节疼痛数、关节肿胀数、晨僵持续时间、红细胞沉降率、类风湿因子、C反应蛋白明显优于小剂量组和对照组,差异有统计学意义（P＜0.05）.三组治疗前及治疗后6,12个月骨密度、Larsen关节评分比较差异无统计学意义（P＞0.05）.对照组非甾体抗炎药（NSAIDs）使用时间明显长于大剂量组、小剂量组[（51.17±2.56）d比（14.16±0.71）,（26.50±1.59）d],小剂量组明显长于大剂量组,差异有统计学意义（P＜0.05）.大剂量组、小剂量组体质量增加的发生率明显高于对照组[5/16,4/17比4.9％（2/41）],差异有统计学意义（P＜ 0.05）.大剂量组和小剂量组体质量增加主要发生于治疗后1.5个月内,随着糖皮质激素的停用,体质量逐渐回落正常.对照组胃肠道不适的发生率明显高于大剂量组、小剂量组[51.2％（21/41）比2/16,3/17],差异有统计学意义（P＜0.05）.结论 在早期活动性类风湿关节炎患者中应用大剂量糖皮质激素可以迅速缓解患者的临床症状及控制患者的炎性反应.除了使患者的体质量短暂增加外,没有给患者带来太多的不良反应;反而因为减少了NSAIDs的使用,使患者胃肠道不适的发生率大大降低.

Objective To investigate the effects and adverse reactions of high-dose glucocorticoid on early active rheumatoid arthritis patients.Methods The early active rheumatoid arthritis patients were randomly divided into three groups：high dose group （16 patients,with large doses of glucocorticoid therapy）,low dose group （17 patients,with small doses of glucocorticoid therapy）,and control group （41 patients,with no glucocorticoid therapy）.Compared the differences among the three groups.Results The changes in the three groups were different in joint pain,joint swelling,morning stiffness,erythrocyte sedimentation rate,rheumatoid factor and C-reactive protein （P 〈 0.05）.The high dose group was significantly better than the other two groups in the above variables alleviating,in the 1 week after the treatment.The changes in the three groups had no significant difference of bone mineral density,Larsen hip score （P〉 0.05）.The NSAIDs days in the control group was significantly longer than the high dose group,low dose group [（51.17 ± 2.56） d vs.（14.16 ± 0.71） d,（26.50 ± 1.59） d],the difference was statistically significant （P 〈 0.05）.Rate of weight gain in the high dose group,low dose group was significantly higher than the control group [5/16,4/17 vs.4.9% （2/41）],the difference was statistically significant （P 〈 0.05）.Body weight increased in the high dose group and low dose group occurred mainly in the following 1.5 months of therapy,with the discontinuation of cortices-teroids,weight gradually fell to normal.Gastrointestinal discomfort incidence in the control group was significandy higher than that in the high dose group,low dose group [51.2% （21/41） vs.2/16,3/17],the difference was statistically significant （P〈 0.05）.Conclusions High-dose glucocorticoid can rapidly relieve clinical symptoms and inflammation in early active rheumatoid arthritis patients.High-dose corticosteroids do not bring too many side effects to patients but weight gain,and it reduces the patients＇ gastrointestinal discomfort greatly,because of the decrease use of NSAIDs.