摘要
目的比较老年类风湿关节炎（RA）患者应用羟氯喹联合来氟米特及单用羟氯喹治疗对血脂及疾病活动相关指标的影响。方法选择2005年1月至2014年6月在我院治疗老年RA患者140例（RA组），以年龄、性别相匹配的健康体检者100例为对照组，比较RA患者血脂特点。再将RA患者随机分为羟氯喹单药治疗（单药治疗组）及来羟氯喹联合来氟米特治疗（联合治疗组）组，每组70例，测定两组治疗前及治疗6个月后的血脂、疾病活动评分（DAS28）、红细胞沉降率、C-反应蛋白（CRP）等变化。结果（1）治疗前，RA组与对照组比较，血总胆固醇、低密度脂蛋白胆固醇（LDL—C）、三酰甘油升高（均P〈0.05），高密度脂蛋白胆固醇（HDL-C）降低（P〈0.05）；（2）治疗6个月后，RA组患者DAS28、红细胞沉降率、CRP、肿胀关节数、压痛关节数、晨僵时间与治疗前比较均明显降低，差异均有统计学意义（P〈0．05）；与治疗前比较，治疗后单药治疗组及联合治疗组HDL-C增高，LDL—C降低，差异均有统计学意义（P〈0.05）；联合治疗组总胆固醇亦有明显下降（P〈0．05）；但两组三酰甘油差异均无统计学意义（P〉o．05）；（3）治疗后，联合治疗组与单药治疗组比较，总胆固醇及LDL-CC水平下降更为显著（P〈0.05），红细胞沉降率、CRP、DAS28、肿胀关节数、压痛关节数明显均明显好转（均P〈0.05）。结论RA患者存在血脂水平异常，羟氯喹＋来氟米特联合治疗在控制炎症同时亦可改善血脂异常，且效果优于单用羟氯喹治疗，可能使RA患者动脉粥样硬化及心血管事件的风险降低。
Objective To investigate the effect of Hydroxychloroquine plus Leflunomide on the lipid profile and disease activity index in patients with rheumatoid arthritis （RA）. Methods A total of 140 elderly patients with RA who met the American College of Rheumatology （ACR） criteria were treated with Hydroxychloroquine （ Group A, n = 70 ） or leflunomide combined with hydroxychloroquine （Group B, n： 70）, and 100 healthy volunteers were selected as controls. The lipid profile was compared between the patient groups and control group. Lipid levels, Disease Activity Score 28 （DAS28）, erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） were measured before treatment and 6 months after treatment between Group A and Group B. Results Compared with the control group, RA patients exhibited higher levels of total cholesterol （TC, P〈 0.05）, low-density lipoprotein cholesterol （LDL C, P〈0.05） and triglycerides （TG, P〈0.01）, and lower levels of high-density l ipoprotein cholesterol （HDL-C, P〈0.05）. After 6 months of treatment, the disease activity index （DAS28, P〈0.01）, the duration of morning stiffness （ P〈0.01）, ESR, CRP, swollen joint count （SJC） and tender joint count （TJC） decreased in RA patients, compared with controls （P〈0.01 or 0.05）. HDL-C levels increased and LDL-C levels decreased in Groups A and B after treatment, compared with pretreatment （P〈0.05 for all）. After treatment, TC levels decreased in Group 13, compared with Group A （P〈0.05）, while TG levels had no significant difference between the two groups （P〉0.05）. TC and LDL-C levels, ESR, CRP, DAS28, SJC and TJC were lower in Group B than in Group A （all P〈0.05）. Conclusions Hydroxychloroquine in combination with Leflunomide therapy can not only control inflammation but also improve the lipid profile, and is more effective than single-drug therapy. The combination may reduce the risk of atherosclerosis and cardiovascular events in patients with RA.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2015年第8期889-892,共4页
Chinese Journal of Geriatrics
关键词
关节炎
类风湿
高脂血症
抗风湿药
Arthritis, rheumatoid
Hyperlipidemiasl Antirheumatic agents
