来氟米特联合甲氨蝶呤治疗活动性类风湿性关节炎78例的临床观察

The clinical observation of leflunomide combined with methotrexate in the treatment of 78 patients with active rheumatoid arthritis

目的研究来氟米特(LEF)联合甲氨蝶呤(MTX)治疗活动性类风湿性关节炎(RA)的效果及安全性。方法156例活动性RA患者,随机分为对照组和联合组,各78例。对照组采用MTX治疗,联合组在MTX的基础上联用LEF治疗。比较两组临床症状改善情况、炎症情况、不良反应发生情况。结果治疗后,两组晨僵持续时间、关节压痛、关节肿胀均较治疗前改善,且联合组晨僵持续时间(54.32±25.51)min短于对照组的(76.38±26.56)min,关节压痛(8.29±5.02)个、关节肿胀(7.02±5.01)个少于对照组的(10.24±5.54)、(9.39±4.52)个,差异有统计学意义(P<0.05)。治疗后,两组超敏C反应蛋白(hs-CRP)、血沉(ESR)水平均明显下降,且联合组低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论LEF联合MTX与MTX单药治疗相比较,两药联合更能够缓解活动性RA患者的临床症状,并同时降低炎症水平,且并不会使不良反应明显增加。

Objective To study the effect and safety of leflunomide(LEF)combined with methotrexate(MTX)in the treatment of 78 patients with active rheumatoid arthritis(RA).Methods A total of 156 patients with active RA were randomly divided into control group and combination group,with 78 cases in each group.The control group was treated with MTX,and combination group was treated with LEF on the basis of MTX.The improvement of clinical symptoms,inflammatory status,and occurrence of adverse reactions were compared between the two groups.Results After treatment,the duration of morning stiffness,number of joint tenderness and joint swelling of the two groups were better than those before treatment;the duration of morning stiffness(54.32±25.51)min of the combination group was shorter than(76.38±26.56)min of the control group,and number of joint tenderness(8.29±5.02)joints and number of joint swelling(7.02±5.01)joints were less than(10.24±5.54)and(9.39±4.52)joints of the control group.All the difference was statistically significant(P<0.05).After treatment,the high sensitivity C-reactive protein(hs-CRP),erythrocyte sedimentation rate(ESR)levels of the two groups were obviously lower than those before treatment,and the combination group was lower than the control group.All the difference was statistically significant(P<0.05).There was no statistically significant difference in incidence of adverse reactions between the two groups(P>0.05).Conclusion Compared with MTX alone,combination of LEF and MTX can relieve the clinical symptoms of patients with active RA,reduce the level of inflammation,without increasing the adverse reactions.