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目的 探讨对类风湿关节炎 (RA)联合使用改善病情抗风湿药 (DMARDs)的疗效与易感HLA DR4基因携带的关系。方法 测定RA患者HLA DR4携带频率 ,并作病程、关节功能及红细胞沉降率 (ESR)、C反应蛋白 (CRP)、类风湿因子 (RF)比较分析后 ,分别于阳性者及阴性者联用甲氨蝶呤 (MTX)、柳氮磺吡啶 (SASP)及氯喹 (CQ)等DMARDs ,并观察疗效。结果 HLA DR4携带使患者ESR、CRP及RF值升高 ,使RA病情复杂化 ,给联合治疗带来困难 ,表现在控制症状及生化指标恢复正常值的时间上 ,HLA DR4阳性组比HLA DR4阴性组显著延迟 ;在RF值恢复正常方面 ,HLA DR4阳性组比HLA DR4阴性组病例显著减少 ,上述两方面与RA预后密切相关。在药物的副作用方面 ,两组差异无显著性。结论 HLA DR4可作为判断RA治疗的重要预后指标。
Objective To explore the relationship between the therapeutic effect of combined use of rheumatoid arthritis (RA) and anti-rheumatic drugs (DMARDs) and the susceptibility of HLA DR4 gene. Methods The frequency of HLA DR4 carrier in RA patients was determined and compared with the course of disease, the function of joint, the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and rheumatoid factor (RF) Methotrexate (MTX), sulfasalazine (SASP) and chloroquine (CQ) and other DMARDs, and observe the effect. Results The HLA DR4 carrier increased the ESR, CRP and RF in patients, complicating the RA and making the combination therapy difficult. The results showed that HLA DR4-positive patients were more negative than HLA-DR4-negative patients in control of symptoms and biochemical parameters recovery time Group was significantly delayed; in the RF value returned to normal, the HLA DR4 positive group than the HLA DR4 negative cases significantly reduced, both of the above and RA prognosis are closely related. There was no significant difference between the two groups regarding the side effects of the drug. Conclusion HLA DR4 can be used as an important prognostic indicator for the treatment of RA.