来氟米特和甲氨蝶呤联合糖皮质激素治疗类风湿关节炎不良反应的临床分析

目的 分析来氟米特和甲氨蝶呤联合糖皮质激素(GCs)治疗类风湿关节炎(RA)的不良反应, 提高在临床上使用来氟米特和甲氨蝶呤规范化治疗RA时,对应用糖皮质激素的认识.方法 记录226例RA患者的临床资料,均使用来氟米特和甲氨蝶呤治疗,分为未用GCs治疗组、联合GCs的小剂量组(≤10mg)、中剂量组(11～30mg),用X~2检验或确切概率法比较3组患者的药物不良反应.结果 随访24周,71例未用过GCs组发生皮疹、口腔溃疡、肝损害、血白细胞减少的分别17%、16%、24%、17%;72例小剂量组分别为3%、4%、7%、7%;34例中剂量组分别为3%、3%、9%、3%,小、中剂量组与未用过GCs组相比发生率显著减少(P<0.05).中剂量组发生骨质疏松、非外伤骨折、糖尿病、高血脂、高血压分别为32%、18%、35%、38%、29%,与未用过GCs组相比发生率均明显增加(P<0.05).小剂量组骨质疏松、糖尿病、高血压的发生率较未用GCs组无明显改变(P>0.05).结论 来氟米特和甲氨蝶呤联合GCs治疗RA,皮疹、肝损害、口腔溃疡等不良反应的发生率降低;小剂量GCs治疗者对骨密度、血糖和血压的影响不明显;中剂量GCs治疗发生骨质疏松及非外伤骨折、高血糖、高血脂、高血压的风险增加.

Clinical analysis of adverse reactions on rheumatoid arthritis treated with leflunomide and methotrexate and glucocorticoid

Objective To analyze the adverse reactions of leflunomide and methotrexate combined with glucocorticoids (GCs) on the treatment of patients with rheumatoid arthritis (RA), and to improve the understanding of GCs. Methods The clinical data of 226 cases with RA were collected. All the cases received treatment of leflunomide and methotrexate for RA. The patients were divided into three groups, including non- GCs group, small-dose GCs group (≤ 10 mg) and middle-dose GCs group (11~30 mg). The adverse reactions of the three groups were compared by Chi-square test or Fisher's exact test. Results At the 24th weeks of follow-up,the non-GCs group had high incidence of skin rash (16.9%), mouth ulcers (15.5%), blood leuco-penia (23.9%), and liver damage (16.9%). The incidence of above adverse reactions in the small-dose GCs and middle-dose GCs group was 2.8-4.2-6.9-6.9% and 2.9-2.9-8.8-2.9%, respectively, both were significantly lower than that of the non-GCs group (P<0.05). But the incidence of osteoporosis, non-traumatic fracture,diabetes,hyperlipidemia and hypertension in the middle-dose GCs group was 32.4-17.6-35.2-38.2-29.4%, respectively, was statistically higher than that in the non-GCs group (P<0.05). The incidence of osteoporosis, diabetes and hypertension in the small-dose GCs group was not statistically different from that of the non-GCs group (P>0.05). Conclusion The incidence of skin rash, liver damage and mouth ulcers is low when leflunomide and methotrexate combined with GCs are implemented for the treatment of RA,.No significant adverse effects are observed on blood pressure, blood glucose level, and bone density in long-term treatment with low-dose GCs.