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目的 比较在应用非甾体消炎镇痛药 (NSAIDs)基础上用和不用甲氨蝶呤 (MTX)对类风湿关节炎 (RA)病人生活质量变化的影响 ,从而明确在RA治疗方案中早期应用MTX的必要性。方法 13 6例病例来源于随机对照临床试验 ,本研究第一部分制定的RA生活质量量表作为本研究测量的工具。结果 13 2例类风湿关节炎病人完成治疗。MTX组治疗前后生理、心理、社会、健康自我认识和总体生活质量改善值中位数分别为 3 5、2 0、3 0、2 0、2 3 ,较治疗前水平改善 10 %～ 2 5 % ,优于对照组改善 1%～ 11% (相应改善值中位数为 2 0、1 5、1 5、0、2 1,P值分别为 0 0 1、0 2 8、0 13、0 0 0 5、0 0 3 )。MTX组疗效高的病人治疗前生理功能分和总体生活质量分较疗效低组高 ,而心理功能分较低分组低 ,治疗后生活质量改善也明显。MTX组总体生活质量改善分高的病人组临床指标改善优于低分组。结论 MTX治疗成年人活动性RA生活质量较单用非甾体消炎镇痛药有更高的生活质量 ,尤其是治疗前生理功能明显受限 ,生活质量差而心理功能较好的活动性RA病人。
Objective To compare the effects of methotrexate (MTX) on quality of life in patients with rheumatoid arthritis (RA) on the basis of NSAIDs and to identify the early application of RA in the treatment of rheumatoid arthritis Necessity of MTX. Methods Thirteen of six patients were from randomized controlled clinical trials. The RA Quality of Life Scale developed in the first part of this study was used as a measure of this study. Results 132 cases of rheumatoid arthritis patients completed treatment. The mean values of physical, mental, social and health self-awareness and overall quality of life before and after treatment in MTX group were 35,200,300,2,0,23, respectively, which were 10% -25% better than those before treatment , Better than the control group improved 1% to 11% (corresponding improvement median of 20,1 5,1 5,0,2 1, P values were 0 0 1,0 2 8,0 13,0 0 0 5,0 0 3). The patients with high curative effect in MTX group had lower scores of physiologic function and overall quality of life before treatment than those with lower curative effect, while those with lower scores of psychological function were lower, and the quality of life improved significantly after treatment. The improvement of clinical indexes in MTX group with higher total quality of life improved better than the low group. Conclusion MTX treatment of adult active RA quality of life than single non-steroidal anti-inflammatory analgesic drugs have a higher quality of life, especially in patients with significantly limited physiological function before treatment, poor quality of life and better psychological function of active RA patients .