摘要
目的:比较不同治疗方案在类风湿关节炎(RA)缓解后维持治疗中的疗效和安全性,探讨RA缓解后的优选维持治疗方案。方法:收集、整理经治疗达到缓解并于皖南医学院附属弋矶山医院长期随访的114例RA患者的临床资料,并进行回顾性分析。按所采用的维持治疗方案不同分为甲氨喋呤+来氟米特(MTX+LEF)组、MTX组及LEF组,比较患者的一般临床资料、不同时间段内各组方案的复发率及药物不良反应发生率。三组间计量资料的比较采用F检验,偏态资料采用秩和检验,计数资料采用χ2检验或Fisher's确切概率,相关性分析采用Pearson相关分析。结果:在第6个月,MTX+LEF组、MTX组及LEF组复发率分别为3.51%、8.57%、15.79%,各组间差异无统计学意义(P>0.05)。在第12、18、24个月,LEF组复发率均高于MTX+LEF组及MTX组,且差异均有统计学意义(P<0.05),其中第24个月,MTX+LEF组、MTX组及LEF组复发率分别为34.78%、31.58%、81.82%。在各组方案维持治疗期间,MTX+LEF组、MTX组及LEF组不良反应发生率分别为37.29%、5.56%、15.79%,MTX+LEF组明显高于MTX组及LEF组。结论:在RA缓解后维持治疗期间MTX组较LEF组复发率低,与MTX+LEF组效果相当;而MTX组较MTX+LEF组药物不良反应发生少;故MTX单独使用有可能成为缓解后病情长期稳定的RA患者安全、有效、经济的维持治疗手段。
AIM： To compare the efficacy and safety of different maintenance treatments in patients with rheumatoid arthritis（ RA） after sustained remission. METHODS： 114 patients who met the1987 American College of Rheumatology（ ACR）Classification criteria for RA were enrolled into the study. The clinical data of patients who had reached clinical remission and have adhered to long-term follow-up at Yijishan Hospital of Wannan Medical College were collected and analyzed retrospectively.The patients were divided into 3 different groups according to the maintenance treatments. The methotrexate（ MTX） ＋ leflunomide（ LEF） group,MTX group and the LEF group were involved. General demographic data,relapse rate at different visiting time and incidence of adverse events were compared.Normal distribution data were analyzed by one-way ANOVA test,while non-normal distribution data by Kruskal-Wallis H test,count data by Chi-square test or Fisher ＇s exact test,and correlation analysis by Pearson. RESULTS： At the time of 6th month after remission,the relapse rate among the MTX ＋ LEF group,MTX group and the LEF group were 3. 51%,8. 57%,15. 79% respectively（ P〈0. 05）. At the12 th,18th and 24 th month,the relapse rate of LEF group was higher than that of both MTX ＋ LEF and MTX groups,and the difference was statistically significant（ P〈0. 05）. At the 24 th month,the relapse rate was 34. 78%（ MTX ＋ LEF group）,31. 58%（ MTX group） and 81. 82%（ LEF group）. During the period of maintenance treatment,the incidence of adverse events for MTX ＋ LEF,MTX and LEF groups were 37. 29%,5. 56% and 15. 79% respectively. CONCLUSION： During the maintenance therapy periods in RA after remission,the relapse rate in MTX group was lower than that of LEF group,but was similar to that of MTX ＋ LEF group.Whereas,the incidence of drug adverse events in MTX group was lower than that of MTX ＋ LEF group. Therefore,MTX treatment alone may be safer,more effective and more economical maintenance treatment for RA p
出处
《中国临床药理学与治疗学》
CAS
CSCD
2015年第7期797-802,共6页
Chinese Journal of Clinical Pharmacology and Therapeutics
关键词
类风湿关节炎
缓解
复发
治疗
rheumatoid arthritis
remission
relapse
treatment
