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目的观察甲氨蝶呤(MTX)对强直性脊柱炎(AS)髋关节病变的临床疗效,并以柳氮磺吡啶(SSZ)作为对照,以评价MTX对AS髋关节病变的有效性及安全性。方法从住院的AS髋关节病变患者中随机选择MTX治疗的48例为观察组,并以年龄、性别、病程及病情相匹配,采用SSZ治疗的50例作为对照组,两组患者均选择一种非甾体抗炎药作为基础疗法。出院后继续原药物治疗,并随访3年的临床资料,包括临床症状、Bath AS活动指数(BASDAI)、Bath AS功能指数(BASFI)、髋关节功能评分、髋关节病变CT分期、炎性指标等实验室检查及不良反应。结果观察组第1、2、3年随访44、38、32例,对照组分别为45、38、31例。随访3年内,髋关节功能评分观察组显著高于对照组(P<0.05)。髋关节CTⅠ期病变,两组患者随访第2、3年与入院时比较明显减少(P<0.05);随访第2、3年,观察组比对照组显著下降(P<0.05)。髋关节CTⅡ期病变,两组间各时段比较差异均无统计学意义。腰痛、腰背晨僵、BASDAI和BASFI、红细胞沉降率(ESR)、C反应蛋白(CRP),两组间对比差异均无统计学意义。不良反应以胃肠道反应为主,两组比较差异无统计学意义;随访所有病例无造血系统障碍发生。结论MTX对AS髋关节病变的疗效优于SSZ,在治疗3年内髋关节功能明显改善;MTX不良反应较轻,可作为治疗AS髋关节病变的首选药物,其更长期的疗效及安全性有待进一步观察。
Objective To observe the clinical efficacy of methotrexate (MTX) in the treatment of hip joint disease in ankylosing spondylitis (AS) and to evaluate the efficacy and safety of MTX on AS hip joint disease with sulfasalazine (SSZ) as a control . Methods Forty-eight patients with AS hip arthroplasty who were randomly selected from the hospital were randomly divided into observation group and control group according to their age, sex, course of disease and disease. Fifty patients treated with SSZ were selected as control group. Non-steroidal anti-inflammatory drugs as a basis for treatment. After discharge from the hospital, the treatment was continued and the clinical data were followed up for 3 years, including clinical symptoms, Bath AS activity index (BASDAI), Bath AS function index (BASFI), hip function score, CT staging of hip disease, inflammatory indexes Laboratory tests and adverse reactions. Results The observation group were followed up 44, 38, 32 cases in the first, second, and third years, while the control group were 45, 38, and 31 cases respectively. Within 3 years of follow-up, the hip function score observation group was significantly higher than the control group (P <0.05). At the second and third year of follow-up, the observation group showed a significant decrease (P <0.05) compared with the control group at the second and third year of follow-up. Hip CT Ⅱ disease, the difference between the two groups was not statistically significant. Low back pain, morning back stiffness, BASDAI and BASFI, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) had no significant difference between the two groups. Adverse reactions were mainly gastrointestinal reactions, with no significant difference between the two groups. All cases were followed up for hematopoietic disorders. Conclusions MTX is superior to SSZ in the treatment of AS hip joint disease. The function of MTX is improved obviously in 3 years after treatment. MTX is less toxic and can be used as the first choice for treatment of hip joint disease in AS. Its longer-term efficacy and safety need further Observed.