应用不同剂量甲氨蝶呤治疗类风湿关节炎对血浆同型半胱氨酸浓度影响的临床观察

Clinical observation on effect of application of different doses of methotrexate for the treatment of rheumatoid arthritis on plasma homocysteine concentration

[目的]旨在观察应用不同剂量甲氨蝶呤治疗类风湿关节炎患者,检测血浆同型半胱氨酸浓度的改变,以了解对心血管疾病发生率的影响。[方法]选择63例2015年11月-2016年5月在我院门诊和住院的类风湿关节炎患者,随机分为两组,第一组32例,治疗为口服甲氨蝶呤片(15 mg/周)及应用甲氨蝶呤后第24小时口服叶酸片(5 mg/周),第二组31例,治疗为皮下注射甲氨蝶呤针(25 mg/周)及应用甲氨蝶呤后第24小时口服叶酸片(5 mg/周),两组治疗同时联用糖皮质激素(5 mg,2次/d)口服,一月后减量为(5 mg,1次/d),两月后停用糖皮质激素。两组患者分别在治疗前、初始应用甲氨蝶呤后第24 h、初始应用甲氨蝶呤后第48 h、治疗3个月、治疗半年时各采血1次,应用HCY方法学循环酶法检测血浆同型半胱氨酸浓度。[结果]两组患者血浆同型半胱氨酸浓度在应用甲氨蝶呤治疗后第24 h出现短暂的升高,在应用甲氨蝶呤后第48小时大部分回到血浆同型半胱氨酸浓度的基线水平,两组患者应用不同剂量甲氨蝶呤联合叶酸治疗过程中血浆同型半胱氨酸浓度升高的差值没有统计学意义。[结论]类风湿关节炎患者在接受甲氨蝶呤联合叶酸治疗中,血浆同型半胱氨酸的浓度并不因为甲氨蝶呤的剂量增加而显著升高,从而导致心血管事件的发生率增加。

[Objective]This study was designed to investigate the application of different doses of methotrexate in the treatment of patients with rheumatoid arthritis, detection of plasma homocysteine concentration change, in order to understand the effects on the incidence of cardiovascular disease. [Methods]63 cases in 2013 November -2014 year in May in our hospital out-patient and hospitalization of patients with rheumatoid arthritis, were randomly divided into two groups, the first group of 32 cases, the treatment for oral Methotrexate Tablets （15 mg/w） and the application of methotrexate twenty-fourth hours after oral administration of Folic Acid Tablets （5 mg/w） , the second group 31 cases, subcutaneous injection of methotrexate treatment needle （25 mg/w） and the application of methotrexate twenty-fourth hours after oral administration of Folic Acid Tablets （5 mg/w） , two groups of treatment combined with Glucocorticoid （ 5 mg bid） orally, in January after the reduction of （ 5 mg QD） , two months after discontinuation of corticosteroids. Two groups of patients were twenty-fourth before treatment, the initial application of methotrexate after hours, forty-eighth hours after the initial application of methotrexate, treatment for 3 months, the first half of the blood 1 times during treatment, enzymatic cycling method using HCY method for detection of plasma homocysteine concentration. [Results] the concentration of homocysteine in plasma in two groups of patients treated by methotrexate twenty- fourth hours after the transient rise, most in forty-eighth hours after the application of methotrexate returned to baseline levels of plasma homocysteine concentration, the difference of two groups of patients with different doses of methotrexate combined with folic acid during the treatment of plasma homocysteine concentration elevated not statistically significance. [Conclusion] in patients with rheumatoid arthritis receiving methotrexate combined with folic acid treatment, the plasma concentration of homocysteine is not because the dose of methotrexate increased significantly, leading to the incidence of cardiovascular events increased.