糖皮质激素治疗类风湿关节炎的初步临床分析

目的初步探讨糖皮质激素（glucocorticoids,GCs）在类风湿关节炎（rheumatoid arthritis,RA）中使用的利弊。方法随机调查53例RA患者使用GCs的情况（非激素组25例,激素组28例）,详细记录GCs使用的剂量、时间,同时测定所有患者的临床及相关实验室指标,比较非激素组和激素组RA患者间上述指标的差异。结果两组患者间年龄、BM I、病程、性别构成以及是否使用改变病情抗风湿药物等基本情况比较显示,差异无统计学意义（P〉0.05）。非激素组与激素组在关节压痛指数（21.92±15.52）vs（35.39±17.53）、关节肿胀指数（8.88±6.21）vs（12.61±6.66）、HAQ积分（0.83±0.69）vs（1.76±0.80）、患者评价（5.44±1.80）vs（6.61±1.50）、关节功能分级构成比（1∶13∶10∶1）vs（0∶5∶12∶11）、关节X线分期构成比（6∶14∶4∶1）vs（1∶12∶8∶7）及骨质疏松发生率（5/25vs13/28）的比较显示,差异有统计学意义（P〈0.05）。服用激素的总量与关节压痛指数（r=0.308,P=0.025）、HAQ积分（r=0.549,P=0.0001）、患者评价（r=0.301,P=0.028）、双手平均握力（r=-0.337,P=0.014）和桡骨远端骨密度（r=-0.362,P=0.008）呈直线相关。结论不适当使用GCs治疗的RA患者关节压痛和肿胀数更多,HAQ积分更高,患者评价、关节功能和关节X线分期更差,骨质疏松的发生率亦更高;但每日3片左右的强的松使用1.5年对RA血压、血糖和血脂的影响并不大。

Clinical analysis on rheumatoid arthritis treated with glucocorticoids

Objective To investigate the benefit and harm of glucocorticoids(GCs)treatment on patients with rheumatoid arthritis(RA).Methods Clinical data of 53 patients with RA were analyzed randomly.The dosage and duration of GCs were noted in details.All the clinical and laboratory factors were compared between group of GCs(n=28),who were treated with GCs previously or currently,and group of non-GCs,who were treated with GCs never(n=25).Results There were no significant differences in age,sex,index of avoirdupois,duration of disease,ratio of patients who were treated with disease modifying anti-rheumatism drugs or not between group of GCs and non-GCs.Patients who were treated with GCs previously or currently had more worse of index of swollen or tenderness of joint,scores of HAQ,assessment of patients,function of joint,radiographic change of joint than those of patients who were treated with GCs never(P<0.05).Patients in group of GCs also had higher rate of osteoporosis than those of patients in group of non-GCs(13/28 versus 5/25,P<0.05).There was a linear correlation between the cumulated dosages of GCs and index of tenderness of joint(r=0.308,P=0.025),scores of HAQ(r=0.549,P=0.0001),assessment of patients(r=0.301,P=0.028),average grip strength of two hands(r=-0.337,P=0.014),bone mineral density of ultra-radio(r=-0.362,P=0.008).Conclusion Patients with RA who were treated with un-appropriate GCs had no clinical improvement,but had more ratio of osteoporosis.It was harmless for blood pressure,blood sugar,serum cholesterin and glyceride of patients with RA who treated with predison 15 mg per day for 1.5years.