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目的观察类风湿关节炎继发骨质疏松患者联合利塞膦酸钠与来氟米特治疗疾病的临床效果。方法采用随机数字表法将我院2012年11月—2014年11月收治的80例类风湿关节炎继发骨质疏松患者分为两组,对照组口服来氟米特10mg/次,1次/d;观察组在对照组的基础上口服利塞膦酸钠5 mg/次,清晨进食前30 min温水送服,两组均治疗1年。对比疗效、腰椎及股骨颈骨密度(bone mineral density,BMD)、ESR、CRP,并对关节肿胀指数和关节压痛指数进行对比,计量资料采用t检验,计数资料采用χ~2检验,P<0.05为差异有统计学意义。结果观察组总有效率为90.0%,与对照组的72.5%对比差异有统计学意义(P<0.05)。观察组治疗后腰椎及股骨颈BMD分别为(1.017±0.089)、(0.901±0.050)g/cm~3,显著优于对照组的(0.900±0.060)、(0.812±0.055)g/cm~3,对比差异均有统计学意义(均P<0.05)。观察组关节肿胀指数、压痛指数、CRP及ESR水平分别为(9.2±3.7)、(12.7±3.8)、(21.6±7.5)mg/h、(44.6±20.2)mm/h,显著优于对照组的(10.6±2.4)、(15.4±4.6)、(25.5±7.7)mg/h、(58.7±31.1)mm/h,对比差异均有统计学意义(均P<0.05)。结论联合利塞膦酸钠与来氟米特治疗类风湿关节炎继发骨质疏松症,对患者BMD的提高、类风湿性关节炎病情的抑制具有明显效果,值得临床进一步推广和使用。
Objective To observe the clinical effects of combination of risedronate and leflunomide in the treatment of rheumatoid arthritis secondary osteoporosis patients. Methods Eighty patients with rheumatoid arthritis secondary osteoporosis admitted from November 2012 to November 2014 in our hospital were randomly divided into two groups. The control group received leflunomide 10 mg once daily, / d. The observation group was given oral risedronate 5 mg / time on the basis of the control group, warm water was delivered 30 min before the morning meal, both groups were treated for 1 year. The curative effect, lumbar and femoral neck bone mineral density (BMD), ESR and CRP were compared. The joint swelling index and joint tenderness index were compared. The measurement data were analyzed by t test. The count data were analyzed byχ ~ 2 test, P <0.05 For the difference was statistically significant. Results The total effective rate in the observation group was 90.0%, which was significantly lower than that in the control group (72.5%) (P <0.05). The BMD of the lumbar spine and femoral neck in the observation group were (1.017 ± 0.089) and (0.901 ± 0.050) g / cm ~ 3, respectively, which were significantly better than those in the control group (0.900 ± 0.060 and 0.812 ± 0.055 g / cm3 , The differences were statistically significant (P <0.05). The joint swelling index, tenderness index, CRP and ESR in the observation group were (9.2 ± 3.7), (12.7 ± 3.8), (21.6 ± 7.5) mg / h and (44.6 ± 20.2) mm / h respectively (10.6 ± 2.4), (15.4 ± 4.6), (25.5 ± 7.7) mg / h and (58.7 ± 31.1) mm / h, respectively. There were significant differences between the two groups (all P <0.05). Conclusion Combined use of risedronate sodium and leflunomide in the treatment of osteoporosis secondary to rheumatoid arthritis has significant effect on the improvement of patients’ BMD and on the condition of rheumatoid arthritis. It is worth further clinical promotion and use.