来氟米特联合甲氨喋呤治疗类风湿关节炎临床观察

Clinical observation of leflunomide combined with methotrexate in the treatment of rheumatoid arthritis

目的观察来氟米特(LEF)联合甲氨喋呤(MTX)治疗类风湿关节炎(RA)的临床疗效及不良反应。方法将RA患者52例随机分为治疗组和对照组各26例,治疗组给予LEF联合MTX治疗,对照组给予LEF联合雷公藤多苷治疗。比较2组患者治疗前及治疗3、6个月后的关节疼痛、压痛、肿胀数及晨僵改善情况和红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)水平、临床疗效和药物不良反应。结果治疗前2组关节疼痛、压痛、肿胀数、晨僵时间、ESR、CRP及RF比较差异均无统计学意义(P>0.05);治疗6个月后2组上述指标均较治疗前改善,且治疗组晨僵时间、ESR、CRP及RF均明显低于对照组,差异均有统计学意义(P<0.05);2组治疗6个月后关节疼痛、压痛、肿胀数比较差异均无统计学意义(P>0.05)。2组治疗3、6个月ACR20缓解率及治疗3个月ACR20缓解率组间比较差异均无统计学意义(P>0.05),治疗组治疗6个月后ACR50缓解率明显高于对照组,差异有统计学意义(P<0.05)。治疗组不良反应发生率为57.7%略高于对照组的42.3%,但差异无统计学意义(P>0.05)。结论 LEF联合MTX与LEF联合雷公藤多苷均能有效控制活动性RA,但LEF联合MTX疗效更显著,尤其对活动度高的患者较合适;对活动度低的患者应选择不良反应少的联合方案(如LEF联合雷公藤多苷)。

Objective To observe the efficacy and adverse reactions of leflunomide（LEF） combined with methotrexate （MTX） in the treatment of rheumatoid arthritis （RA）. Methods 52 patients with RA were randomly divided into treatment group （n = 26） and control group （n = 26）, the treatment group was treated with LEF combined with MTX, the control group was treated with LEF combined with tripterygium glycosides. The joint pain, tenderness, swelling, morning stiffness improvement, erythrocyte sedimentation rate （ ESR）, C-reactive protein（ CRP）, rheumatoid factor（RF） levels before and after 3 and 6 months of treatment, clinical efficacy and adverse drug reactions in the two groups were compared. Results There was no significant difference in the pain,tenderness, swelling, morning stiffness, ESR, CRP and RF between the two groups before treatment（P 〉0.05）;After 6 months of treatment,the above indicators in both groups were improved compared with before treatment;The morning stiffness time,ESR, CRP and RF in the treatment group were significantly lower than those in the control group（ P 〈 0.05 ） ;There was no significant difference in joint pain ,tenderness, and swelling number between the two groups after 6 months of treatment （ P 〉 0.05 ）. There was no significant difference in the ACR20 remission rate and the 3 months ACR20 remission rate between the two groups at 3 and 6 months （ P 〉 0.05 ）, after 6 months of treatment, the remission rate of ACRSO was significantly higher in the treatment group than in the control group（ P 〈 0.05 ）. The incidence of adverse reactions in the treatment group was higher than that in the control group, but the difference was not statistically significant（ P 〉 0.05 ）. Conclusion LEF combined with MTX or LEF combined with Tripterygium glycosides can effectively control active RA, but LEF combined with MTX is more effective, especially for patients with high activity;patients with low activity should choose a combination of less adverse reactions（ eg LEF in combination with Tripterygium glycosides）.