青藤碱联合甲氨蝶呤对类风湿关节炎骨破坏修复作用的临床研究

目的探讨青藤碱联合甲氨蝶呤治疗类风湿关节炎（RA）并防治骨破坏的临床疗效和安全性。方法 96例RA患者随机分为治疗组（n=48）和对照组（n=48）,所有患者均给予甲氨蝶呤＋双氯芬酸钠缓释胶囊＋叶酸片治疗,疗程为6个月;治疗组加用青藤碱口服。观察两组患者治疗前后症状、体征、血沉（ESR）、C反应蛋白（CRP）、骨密度（BMD）和不良反应等。结果治疗组总有效率为93.75%,显著高于对照组（79.17%,P〈0.05）;治疗组晨僵持续时间、关节肿胀指数、关节压痛指数、关节功能指数及HAQ评分改善程度显著优于对照组（P〈0.05）;治疗后两组ESR和CRP均较治疗前显著降低（P〈0.05）,治疗组BMD较治疗前亦有显著提高（P〈0.05）。治疗组不良反应发生率显著低于对照组（P〈0.05）。结论青藤碱联合甲氨蝶呤治疗RA,可明显改善临床症状,减少不良反应,有效调节骨代谢,延缓甚至减轻患者骨破坏。

Clinical study of sinomenine combined with methotrexate on the repair of bone destruction in rheumatoid arthritis

Objective To explore clinical effect of sinomenine combined with methotrexate for the treatment of rheumatoid arthritis（RA）, and its effect on bone repair. Methods Totally 96 cases of RA patients were randomly divided into two groups. The control group（n=48） was treated with methotrexate plus diclofenac sodium and folic acid sustainedrelease capsule for 6 months. And the treatment group（n=48） was treated with sinomenine additionally. The clinical effect, symptoms changes, ESR, CRP, BMD and adverse reactions in two groups after treatment were observed and compared. Results The total effective rate in treatment group and control group was 93.75% and 79.17%, it was statistically different（P〈0.05）. The symptomes as morning stiff time, index of joint tenderness, swelling, function and HAQ score were significantly improved in treatment group compared with control group after treatment（P〈0.05）. After treatment, the level of ESR, CRP in both groups was remarkablely reduced（P〈0.05）, and the BMD in treatment group was significantly improved than those before treatment（P0.05）. The incidence of adverse reactions in treatment group was significantly lower than that in control group（P〈0.05）. Conclusion Sinomenine combined with methotrexate for RA patients may contribute to improve the clinical symptoms, reduce the adverse reactions, regulate bone metabolism, postpone and even reduce bone destruction.