他克莫司联合甲氨蝶呤治疗难治性类风湿关节炎临床分析

Efficacy of tacrolimus combined with methotrezate in the treatment of patients with refractory rheumatoid arthritis

目的研究他克莫司联合甲氨蝶呤对难治性RA的临床疗效及安全性，并与环磷酰胺联合甲氨蝶呤治疗难治性RA进行对比。方法将36例难治性RA患者分为观察组和对照组。观察组用他克莫司联合甲氨蝶呤治疗，对照组用环磷酰胺联合甲氨蝶呤治疗，采用重复测量方差分析和Fisher确切概率法对2组在8、24周时的疗效进行评估。结果观察组在8、24周的有效率分别77．8％（14例）和100％（18例），对照组分别为11．1％（2例）和44．4％（8例），显示他克莫司＋甲氨蝶呤和环磷酰胺＋甲氨蝶呤对难治性RA都有效，但他克莫司＋甲氨蝶呤比环磷酰胺＋甲氨蝶呤疗效好，CRP和DAS28差异有统计学意义（P〈0．05），能显著改善临床症状和实验室指标。结论他克莫司联合甲氨蝶呤对难治性RA有效，且安全性好，值得推广应用。

Objective To assess the efficacy and safety of tacrolimus （TAC） combined with methotrexate （MTX） for the treatment of refractory rheumatoid arthritis （RA）, and to compare it with cyclophosphamide （CTX） added to MTX for the treatment of refractory RA. Methods Thirty-six cases of refractory RA patients were divided into the observation group and the control group. TAC＋MTX were used in the observation group, and CTX＋MTX were used in the control group. We used repeated measures to analyze the variance and Fisher exact probability method to analyze the efficacy at 8 weeks and 24 weeks. Results The effective rate of the observation group in 8 weeks, 24 weeks were 77.8%（14 cases） and 100%（18 cases） respectively, while those of the control group were 11.1% （2 cases） and 44.4%（8 cases）, it showed that both TAC＋MTX and CTX＋MTX in the＇ treatment of refractory RA were effective, but the efficacy of TAC＋MTX was better than CTX＋MTX, the difference of C reactive protein （CRP） and disease activity score （DAS）28 was statistically significant （P〈0.05）, and it could significantly improve the clinical symptoms and laboratory indexes. Conclusion TAC＋MTX is effective and safe in treating refractory RA, and is worth of spreading.