双醋瑞因联合甲氨蝶呤和来氟米特治疗老年人类风湿关节炎的疗效分析

摘要

目的 分析双醋瑞因联合甲氨蝶呤和来氟米特治疗老年人类风湿关节炎的临床疗效.方法 将我院在2010年9月至2012年12月收治老年类风湿关节炎患者80例分为观察组和对照组各40例,观察组采用双醋瑞因联合甲氨蝶呤和来氟米特治疗,对照组采用甲氨蝶呤和来氟米特治疗;入选患者均排除老年人骨关节炎. 结果 治疗后观察组与对照组比较,关节肿胀数[(0.93±0.21)个比(3.43±0.69)个,t=10.728,P=0.013]、关节压痛数[(1.15±0.46)个比(3.61±0.83)个,t=11.443,P=0.008]减少,晨僵时间[(1.6±2.2) min比(13.5±4.2)min,t=11.164,P=0.011]缩短,双手握力[(7.97±1.53)kPa比(5.68±2.07)kPa,t=10.562,P=0.014)增强;健康评价评分、医生和患者对疾病总体状况的视觉模拟评分及简明活动评分观察组均优于对照组;红细胞沉降率[(9.51±4.32) mm/h比(26.47±6.32)mm/h,t=9.892,P=0.028]、C反应蛋白[(2.34±0.57)mg/L比(8.13±2.14)mg/L,t=9.427,P=0.031]、类风湿因子[(231.3±45.5) kU/L比(283.3±68.4)kU/L,t=10.023,P=0.018]等检测指标观察组均优于对照组,差异均有统计学意义;观察组不良反应率均低于对照组(15.0％和37.5％,x2=5.230,P=0.020). 结论 双醋瑞因联合甲氨蝶呤和来氟米特治疗老年人类风湿关节炎疗效确切,值得临床推广应用.%Objective To analyze the clinical efficacy of diacerein plus methotrexate and leflunomide in the treatment of rheumatoid arthritis in elderly patients.Methods Eighty elderly patients with rheumatoid arthritis seeking treatment at our hospital from September 2010 to December 2012 were divided into the treatment group (n =40) and the control group (n =40).Patients with osteoarthritis were excluded from enrollment.The treatment group was given diacerein,in addition to methotrexate and leflunomide,whereas the control group received methotrexate and leflunomide.Results Compared with the control group,the treatment group showed a lower swollen joint count [(0.93±0.21) vs.(3.43±0.69),t=10.728,P=0.013],a lower tender joint count [(1.15±0.46)vs.(3.6110.83),t=11.443,P=0.008],shorter morning stiffness (1.6±2.2 min vs.13.5±4.2min,t=11.164,P=0.011),and greater hand grip strength [7.97±1.53) kPa vs.(5.68±2.07)kPa,t=10.562,P=0.014].When measured by health assessment questionnaire (HAQ),visual analogue scale (VAS) and DAS28 scores,the treatment group also performed better than the control group.Additionally,the treatment group displayed a more favorable laboratory profile,which included the erythrocyte sedimentation rate (ESR) (9.51±4.32 mm/h vs.26.47±6.32 mm/h,t=9.892,P=0.028),C-reactive protein (CRP) [(2.34±0.57) mg/L vs.(8.13±2.14) mg/L,t=9.427,P=0.031],and rheumatoid factors (RF) [(231.3±45.5) kU/L vs.(283.3±68.4) kU/L,t=10.023,P=0.018].Furthermore,the adverse reaction rate was significantly lower in the treatment group than in the control group (15.0％ vs.37.5％,x2 =5.230,P=0.020).Conclusions Diacerein in combination with methotrexate and leflunomide has shown clearly positive outcomes in the treatment of rheumatoid arthritis in elderly patients and should be recommended in clinical treatment.