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目的:比较沙利度胺联合来氟米特(LEF)及甲氨蝶呤(MTX)与来氟米特(LEF及甲氨蝶呤(MTX)治疗重度疾病活动度类风湿关节炎的疗效和不良反应。方法:将80例DAS类风湿关节炎患者按随机数字表法分为2组:治疗组40例,口服沙利度胺50 mg,1次/d,LEF 20 mg,1次/d,MTX10 mg,1次/w;对照组40例:口服LEF 20 mg,1次/d,MTX 10 mg,每周1次;观察评价关节肿胀压痛数,采用目视10 cm模拟标尺法(VAS)由患者评估病情的整体变化程度,血沉(ESR),类风湿因子(RF)等指标,同时监测患者肝肾功、血尿常规。结果:在疗程第8、12、24、48 w,治疗组患者关节肿胀压痛数、患者VAS评分及血沉改善与对照组比较,差异有显著性;DAS28评分比较发现,治疗组患者达到低疾病活动度比例高于对照组(P<0.05)。结论:沙利度胺联合来氟米特及甲氨蝶呤治疗重度疾病活动度类风湿关节炎疗效优于来氟米特与甲氨蝶呤两药联合。
OBJECTIVE: To compare the efficacy of thalidomide with leflunomide (LEF) and methotrexate (MTX) and leflunomide (LEF and methotrexate (MTX) in the treatment of rheumatoid arthritis with severe disease activity and Adverse reactions.Methods: Eighty patients with DAS were randomly divided into two groups according to random number table: treatment group 40 cases, oral thalidomide 50 mg once a day, LEF 20 mg once a day , MTX 10 mg, once a week; control group 40 patients: oral LEF 20 mg, 1 time / d, MTX 10 mg once a week; observed and evaluated joint swelling and tenderness, visual analog 10 cm The patient’s assessment of the overall degree of change, ESR, RF, and other indicators of liver and kidney function, hematuria routine monitoring.Results: In the treatment of 8,12,24,48 w, the treatment group There were significant differences between the two groups in the number of joint swelling and tenderness, the improvement of VAS score and the improvement of erythrocyte sedimentation rate in the treatment group compared with the control group.Compared with the control group, the DAS28 score found that the proportion of low disease activity in the treatment group was higher than that in the control group (P0.05) Degree of amines combined with leflunomide and methotrexate treatment of severe disease activity of rheumatoid arthritis is better than leflunomide and methotrexate in combination.