柳氮磺吡啶在我国类风湿关节炎患者的用药现况调查

目的:调查和分析类风湿关节炎(rheumatoid arthritis,RA)患者治疗中柳氮磺吡啶(sulphasalazine,SSZ)的使用及其不良反应发生情况。方法:采用流行病学现况调查的研究方法,对北京大学人民医院等全国21家三级甲等医院2009年7月至2010年12月于风湿免疫科门诊及病房就诊的1 096例RA患者进行问卷调查,并详细记录患者的一般资料和临床特点,分析其中160例使用SSZ患者的临床特点、副作用发生情况、SSZ使用现况及联合用药种类和时间等数据。结果:160例患者使用SSZ治疗,使用比例为14.6%。该组患者男女之比为1∶7,平均发病年龄为(46.1±15.0)岁,平均病程为(9.9±7.8)年。SSZ平均用量为(1.87±0.52)g/d,平均用药时间为(26.3±14.6)月。所有患者仅有17%(27/160)使用SSZ单药治疗,其余患者均曾联合应用其他缓解病情抗风湿药(diseasemodifying antirheumatic drugs,DMARDs),其中甲氨蝶呤(methotrexate,MTX)是最常应用的联合治疗药物,占63.1%,平均联合使用MTX时间(28.2±12.3)月;其次为来氟米特(36.2%)和羟氯喹(18.1%);SSZ+MTX是最常见的联合治疗方案(36.2%)。应用SSZ患者的疗效指标优于未应用者。调查时有41.9%(67/160)的患者曾使用SSZ治疗,但因药物不良反应或其他原因而停药。有17.5%(28/160)的患者因不良反应停药,其中因胃肠道反应停药比率(8.8%)最高,其次为皮疹(3.8%)和肝功能异常(3.1%)。结论:与其他国家相比,SSZ在我国应用率偏低,且平均用量上较临床规范用量偏小。SSZ治疗RA不良反应程度较轻,在临床应用中相对比较安全。

Sulphasalazine in patients with rheumatoid arthritis in China: a cross-sectional study

Objective:To investigate the medication status of rheumatoid arthritis(RA) patients and to analyze the clinical use of sulphasalazine(SSZ) and the adverse effect.Methods: A total of 1 096 outpatients and inpatients diagnosed with RA were investigated in 21 hospitals all over China from July 2009 to December 2010,including gender,age of onset,clinical manifestations,as well as the clinical characteristics and medication status of 160 RA patients who received SSZ therapy.Results:In the group of 160 patients who received SSZ,the male-to-female ratio was 1∶ 7,The average age at onset was(46.1±15.0) years,while the average course was(9.9±7.8) years.The average dose of sulphasalazine was(1.87±0.52) g/d for a mean duration of(26.3±14.6) months.Only 17%(27/160) of the patients received SSZ monotherapy.Methotrexate(63.1%),leflunomide(36.2%) and hydroxychloroquine(18.1%) were most commonly used combination drugs.And 36.2%(58/160) of the patients used the two-drug combination of methotrexate plus sulphasalazine.In this group,41.9%(67/160) once used SSZ but withdrew for adverse events and other reasons,while 17.5%(28/160) withdrew for adverse events,of which the most common were gastrointestinal(8.8%),skin(3.8%) and liver toxicity(3.1%).Conclusion:Sulphaszlazine is not a common choice in the RA therapeutics in China,and the average dose of SSZ is lower than the standard dose of 2 to 3 g/d.The adverse events of SSZ are common;however,there are few severe adverse events or threat to life,SSZ is relatively safe in clinical practice.