谊赛普治疗类风湿关节炎90例的疗效观察

目的探讨谊赛普联合甲氨蝶呤及甲泼尼龙治疗类风湿关节炎的效果。方法选取医院2009年5月至2011年5月收治的180例类风湿关节炎患者，按照随机数字表法分为甲氨蝶呤组及甲泼尼龙组，各90例，分别接受谊赛普注射联合甲氨蝶呤片口服或甲泼尼龙片口服治疗，对比两组患者的疗效。结果两组患者治疗后关节肿胀、关节压痛、晨僵持续时间及疼痛视觉模拟评分（VAS）均显著降低（P〈0．05），治疗12周后甲氨蝶呤组关节肿胀个数明显少于甲泼尼龙组，治疗6周及12周甲氨蝶呤组晨僵持续时间及VAS评分均明显低于甲泼尼龙组（P〈0．05）；两组患者关节压痛个数变化无明显统计学差异（P〉0．05）；两组患者治疗后红细胞沉降率、C反应蛋白及类风湿因子水平均显著降低，甲氨蝶呤组改变程度较甲泼尼龙组更为显著（P〈0．05）；甲氨蝶呤组关节压痛和肿胀关节数改善20％（ARC20）35例，ARC5041例，ARC7014例，甲泼尼龙组分别为49例，32例和9例，甲氨蝶呤组治疗效果明显优于后者；两组患者均获得有效随访，甲氨蝶呤组出现1例胃肠道不适，甲泼尼龙组出现2例肌酐升高，均经对症治疗后缓解。结论谊赛普联合甲氨蝶呤在治疗类风湿关节炎中可起到互补作用，有效改善类风湿关节炎患者的临床体征，且起效快、用药时间短，安全性有保障，值得临床推广。

Comparative Observation on Efficacy of Etanercept in Treating Rheumatoid Arthritis

Objective To compare the efficacy of etanercept combined with methotrexate and methylprednisolone in treating of rheumatoid arthritis. Methods One hundred and eighty cases of rheumatoid arthritis admitted to our hospital from May 2009 to May 2011 were selected and randomly divided into the methotrexate group and the methylprednisolone group, ninety cases in each group. The two groups were treated with etanercept injection combined with oral methotrexate tablets or methylprednisolone tablets alone. The efficy was compared between the two groups. Results The joint swelling, joint tenderness, duration of morning stiffness and the VAS scores after treatment in the two groups were significantly decreased（P〈0.05）, the joint swelling number of treating 12 weeks in the methotrexate group was significantly less than that in the methylprednisolone group; the morning stiffness duration and the VAS scores after 6- week and 12-week treatement in the methotrexate group were significantly lower than those in the methylprednisolone group （P〈0.05）; no statistical difference in the joint tenderness number was found between the two groups（P 〉 0. 05）; the erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP） and rheumatoid factor levels after treatment in the two groups were significantly decreased, but the change degrees of the methotrexate group were more significant than the methyl prednisolone group（ P 〈 0.05）; the methotrexate group had 35 cases of the 20% improvement of joint tenderenss and joint swelling number（ARC 20）, 41 cases of ARC 50 and 14 cases of ARC 70, while the methylprednisolone group had 49 cases of ARC 20, 32 cases of ARC 50 and 9 cases of ARC 70 respectively, indicat- ing that the curative effect in the methotrexate group was significantly superior to the latter; the patients in the two groups obtained the effective fallow up, 1 case of gastrointestinal discomfort occurred in the methotrexate group and 2 cases of creatinine increase occurred in the methylprednisolone group, they were relieved by symptomatic treatment. Conclusion Etanercept combined with methotrexate can play a complementary role in the treatment of rheumatoid arthritis, effectively improve the clinical symptoms and signs, and has the ad- vantages of the quick response, short medication time and safeguard to security, which is worthy of clinical promotion.