青霉胺和低剂量糖皮质激素联合依那西普治疗类风湿性关节炎的疗效观察

目的:观察青霉胺和低剂量糖皮质激素联合依那西普(ETA)治疗类风湿性关节炎(RA)的有效性和安全性。方法:将收集的56例活动性RA患者随机分成2组,对照组28例每日口服青霉胺300mg+泼尼松10mg,qd,4周后减量为5mg;试验组在对照组的基础上联合使用ETA,每周皮下注射2次,每次25mg。疗程均为3个月。疗效采用美国风湿病学会(ACR)标准评定。结果:治疗6、12周后,对照组与试验组的实验室指标和临床症状均有改善,ACR20%改善标准(ACR20)有效率分别为21.4%和46.4%、39.3%和64.3%(P<0.05),进一步比较2组治疗前后简明疾病活动评分(DAS28)的变化,发现与治疗前比较,试验组患者DAS28在6周时已出现明显下降(P<0.05)。试验组的不良反应主要是注射部位反应、上呼吸道感染和胃肠道反应;对照组主要为皮疹反应。结论:青霉胺和低剂量糖皮质激素联合依那西普治疗RA安全、有效,且缓解病情时间更短。

Efficacy Observation of Penicillamine and Low Dose of Glucocorticoids with Etanercept in the Treatment of Rheumatoid Arthritis

OBJECTIVE:To observe the effectiveness and safety of penicillamine and low dose of glucocorticoids with etanercept(ETA) in the treatment of rheumatoid arthritis(RA).METHODS:56 cases of RA were randomly divided into 2 groups,28 cases in the control group were given daily oral dose of penicillamine 300 mg+prednisone 10 mg once a day,4 weeks later decreasing to 5mg.The experimental group was given enalapril based on control group,subcutaneous injection twice a week,each time 25 mg.The treatment course lasted for 3 months.The therapeutic efficacy was evaluated by American College of Rheumatology(ACR) standard.RESULTS:After 6 and 12 weeks of treatment,the laboratory index and the clinical symptoms of experimental group and control group were improved,the effective rate of 20% improvement of ACR standard(ACR20) were 21.4% and 46.4%,39.3% and 64.3%(P<0.05).The changes of disease activity score(DAS28) were compared between 2 groups before and after treatment.Compared with before treatment,DAS28 of patients in the experimental group had decreased significantly at 6 week(P<0.05).The most common adverse reactions of experimental group were mainly injection-site reactions,upper respiratory tract infection and gastrointestinal tract reaction;that of control group mainly rash reaction.CONCLUSION:Etanercept is effective and safe in the treatment of RA,can shorten the duration of disease remission.