美洛昔康片联合甲氨蝶呤片治疗类风湿关节炎的临床研究

发布时间：2018-11-19 09:49

【摘要】：目的观察美洛昔康片联合甲氨蝶呤片对类风湿关节炎临床症状和实验室指标的影响。方法 100例类风湿关节炎患者随机分为对照组和试验组,每组50例。对照组口服来氟米特20 mg,每日1次,睡前服用,甲氨蝶呤5 mg,每周1次;试验组口服美洛昔康15 mg,每日1次,甲氨蝶呤5 mg,每周1次。2组均连续用药24周。观察2组患者治疗前后的临床症状和实验室指标。结果治疗后4,12,24周,试验组晨僵时间分别为(78.13±15.24),(62.00±9.31),(35.93±6.12)min,对照组分别为(83.46±17.73),(65.62±11.11),(45.08±9.32)min,与治疗前相比差异有统计学意义(P0.05)。治疗后4,12,24周,试验组关节疼痛数分别为15.05±3.46,10.11±2.83,5.94±1.47,对照组分别为14.17±4.03,9.17±3.13,5.61±1.85,与治疗前相比差异有统计学意义(P0.05)。治疗后4,12,24周,试验组肿胀关节数分别为12.90±3.92,10.00±2.71,5.70±2.41,对照组分别为12.00±3.94,8.33±3.04,4.78±1.72,与治疗前相比差异有统计学意义(P0.05)。治疗后12,24周,试验组红细胞沉降率分别为(32.70±13.52),(28.57±13.87)mm·h~(-1),对照组为(39.29±18.52),(36.00±16.12)mm·h~(-1),差异有统计学意义(P0.05)。治疗后4,12,24周,试验组C反应蛋白分别为(16.60±6.88),(14.70±6.76),(13.11±3.73)mg·L~(-1),对照组分别为(17.05±7.15),(15.40±6.50),(15.02±4.64)mg·L~(-1),与治疗前相比差异有统计学意义(P0.05)。治疗后4,12,24周,试验组抗环瓜氨酸肽抗体分别为(116.96±47.95)(85.31±36.43)(58.82±30.26)U·m L~(-1),对照组分别为(111.37±56.16),(82.66±50.11),(63.24±39.61)U·m L~(-1),与治疗前相比差异有统计学意义(P0.05)。治疗前后,2组类风湿因子差异均无统计学意义(均P0.05)。对照组出现皮疹4例,恶心4例,消化不良6例,脱发1例,药物不良反应发生率为30.00%(15/50例);试验组出现腹痛4例,消化不良1例,皮疹5例,血白细胞轻度下降1例,呕吐3例,药物不良反应发生率为28.00%(14/50例)。2组均未出现严重不良反应,2组药物不良反应发生率差异无统计学意义(P0.05)。结论在甲氨蝶呤基础用药上,联合美洛昔康与来氟米特能明显改善RA患者临床症状和实验室指标,但作用既有共性,又有各自特点。
[Abstract]:Objective to observe the effects of meloxicam tablets combined with methotrexate tablets on clinical symptoms and laboratory indexes of rheumatoid arthritis. Methods 100 patients with rheumatoid arthritis were randomly divided into control group and experimental group with 50 cases in each group. The control group took leflunomide once a day for 20 mg, methotrexate once a week for 5 mg, before bedtime, and the test group took meloxicam once a day for 15 mg, and methotrexate for 5 mg, once a week. The two groups were treated continuously for 24 weeks. The clinical symptoms and laboratory indexes were observed before and after treatment. Results 24 weeks after treatment, the morning stiffness time of the trial group was (78.13 卤15.24), (卤9.31), (35.93 卤6.12) min, control group was (83.46 卤17.73), (65.62 卤11.11), (45.08 卤9.32) min, respectively. The difference was statistically significant compared with that before treatment (P0.05). 24 weeks after treatment, the number of joint pain in the experimental group was 15.05 卤3.46 卤2.83 卤5.94 卤1.47, and in the control group was 14.17 卤4.03 卤3.135.61 卤1.85, which was significantly different from that before treatment (P0.05). At 24 weeks after treatment, the number of swollen joints in the experimental group was 12.90 卤3.92 卤2.71 卤5.70 卤2.41, and that in the control group was 12.00 卤3.94 卤8.33 卤3.04 卤4.78 卤1.72, which was significantly higher than that before treatment (P0.05). The erythrocyte sedimentation rates were (32.70 卤13.52), (28.57 卤13.87) mm h-1 in the experimental group and (39.29 卤18.52), (卤36.00 卤16.12) mm h-1 in the control group, respectively. The difference was statistically significant (P0.05). After 24 weeks of treatment, C-reactive protein in the experimental group was (16.60 卤6.88), () 14.70 卤6.76), (13.11 卤3.73) mg L ~ (-1), and that in the control group was (17.05 卤7.15), (15.40 卤6.50). (15.02 卤4.64) mg L ~ (-1), which was significantly different from that before treatment (P0.05). After 24 weeks of treatment, the anti-cyclic citrullin-peptide antibodies in the experimental group were (116.96 卤47.95) (85.31 卤36.43) (58.82 卤30.26) U m L ~ (-1), in the control group (111.37 卤56.16), () 82.66 卤50.11, respectively. (63.24 卤39.61) U m L ~ (-1), which was significantly different from that before treatment (P0.05). Before and after treatment, there was no significant difference in rheumatoid factors between the two groups (P0.05). In the control group, there were 4 cases of rash, 4 cases of nausea, 6 cases of dyspepsia and 1 case of alopecia. The incidence of adverse drug reaction was 30.00% (15 / 50 cases). There were 4 cases of abdominal pain, 1 case of dyspepsia, 5 cases of rash, 1 case of mild leukopenia and 3 cases of vomiting in the trial group. The incidence of adverse drug reaction was 28.00% (14 / 50 cases). There was no significant difference in the incidence of adverse drug reactions between the two groups (P0.05). Conclusion the combination of meloxicam and leflunomide can significantly improve the clinical symptoms and laboratory indexes of patients with RA.
【作者单位】：安徽中医药大学第一附属医院药学部;安徽医科大学临床药理研究所、抗炎免疫药物教育部重点实验室;安徽中医药大学第一附属医院风湿科;
【基金】：国家自然科学基金资助项目(81473223)
【分类号】：R593.22

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