类风湿关节炎疗效的追踪观察

目的 观察甲氨蝶呤（ＭＴＸ）、柳氮磺吡啶（ＳＡＳＰ）、金诺芬、雷公藤多甙、糖皮质激素和重组人干扰素－γ不同联合治疗方案对类风湿关节炎（ＲＡ）的远期疗效。方法①对１８９例经冶疗后追踪１～６年的ＲＡ病例进行回顾性分析；②治疗方案：基础治疗方案为ＭＴＸ加ＳＡＳＰ，ＭＴＸ加金诺芬，部分病例合并使用雷公藤多甙、糖皮质激素、重组人干扰素－γ；③观察指标：关节临床表现、实验室检查（ＥＳＲ、ＣＲＰ、ＲＦ滴度）和关节Ｘ线片。结果①全组临床疗效评价：症状缓解１１．１％、基本控制４９．７％、进步２７．０％、反复发作或恶化１２．２％；②Ｘ线评价：１２２例作Ｘ线复查。Ｘ线改善６．９％、无改变７７，８％、进展１７．２ ％；③单纯基础治疗组与加用雷公藤多甙或糖皮质激素组比较，其远期临床疗效和Ｘ线变化，两者差异均无显著性；④并用重组人干扰素－γ组２２例。临床疗效：症状缓解４５．５％、进步４０．９％、反复发作或恶化１３．６％Ｘ线评价：改善１例，余均无改变。结论①对ＲＡ采用综合性治疗可取得较满意的疗效；②在基础治疗上加用雷公藤多甙或糖皮质激素，对远期临床疗效和Ｘ线变化无明显影响；应用重组人干扰素－γ与其他二线药合用在一定程度上有扭转病情发展，取?

A follow-up study of rheumatoid arthritis

Objective To investigate long effect of combination therapy. Method ① A retrospective analysis was made in 189 cases being followed up for more than 1 year. Of them, 115 cases were followed up for 2~6 years. ② The combinations of methothexate (MTX) and sulphasalazine (SASP) or MIX and ridaura (auranofin) were used as fundamental treatment. Chinese herbal preparatoin, tripterygium glycosides or glucocorticoid, prednisone was added in some cases. Interferon (INF-γ) was added as a course treatment (3~6 months) in 22 cases. ③ Arthral manifestations, laboratory changes (ESR, CRP, RF), as well as X-ray examination were used as observing indexes. ④ Therapeutic effect was evaluated by both clinical manifestations and radiographic findings. Results ①Clinical evaluation of 189 cases, 11 . 1% with a relief of symptoms, 49 . 7% with a favorite control of the clinical manifestations, 27. 0% with improvement of symptoms and 12.2% with deterioration. ② As for radiological study, of 122 cases with recheck of X-ray at the end of the study, 4.9% with a certain extent of improvement, 77.8% without obvious changes and 17.2% with some deterioration. ③ There were no noticeable differences in late result and radiographic changes between the fundamental group and those who received additive tripterygium glycosides or glucocorticoids (P <0.05) - 22 ④cases who had received additional recombinant human INF-γ showed a clinical effect: remission 45.5 %, improvement 40.9 %, repeated attack or exacerbation 13.6 % and a radiographic finding: 1 case improved, the rest remained unchanged. Conclusion ① This study shows a rather good effect by adopting the above combination therapy. ② Tripterygium glycosides and glucocorticoid may have a short-term effect in improving symptoms, but without effect in long-term treatment and on radiographic findings. ③ INF-γ may be a good drug for relieving symptoms, winning a stable or even improved radiographic finding.