【作者】 崔广梅； 王晓东； 李华南； 王岩艳； 刘华林；

【Author】 CUI Guang-mei,LI Hua-nan,WANG Yan-yan,LIU Hua-lin. Department of Rheumatology and Nephrology,Children Hospital of QingDao,QingDao 266034,China.

【机构】 Department of Rheumatology and Nephrology,Children Hospital of QingDao；

【摘要】 目的探讨早期、甲氨蝶呤(MTX)联合柳氮磺胺吡啶(SASP)与传统的非甾体类抗炎药(NSAIDs)相比较,对幼年附着点炎相关性关节炎(ERA)疗效及预后的影响。方法符合条件的ERA患儿55例,分为对照组25例,采用传统治疗方法 (NSAIDs+必要时小剂量激素);治疗组30例,接受联合免疫抑制治疗(NSAIDs+SASP+MTX)。经过5年的治疗随访,评价两组患儿的临床疗效、放射学进展、转归、安全性。计数资料采用x~2检验或Fisher精确检验,计量资料采用配对t检验。结果治疗前,两组患儿各项主要参数比较,差异无统计学意义(p>0.05)。5年治疗后,治疗组在临床症状、炎性指标、放射学进展方面疗效均优于对照组(p<0.05),治疗组与对照组在病情缓解率(87%与8.7%)和强直性脊柱炎(AS)发生率(4.0%与60.9%)方面差异有统计学意义(p<0.05),在生长发育、不良反应、耐受性方面,两组差异无统计学意义(p>0.05)。结论早期、联合MTX与SASP治疗ERA可以很好的缓解病情,且能延缓或阻止放射学进展,耐受性好,对患儿生长发育无不良影响。更多还原

【Abstract】 Purpose:To investigate the efficacy and prognosis of early combination therapy with methotrexate(MTX) and sulfasalazine(SASP) and traditional therapy with NSAIDs in juvenile onset enthesitis-related arthritis(ERA).Method:55 patients for ERA were divided into control group(n=25) received conventional NSAIDs and low-dose corticoid needed,and treatment group(n=30) received NSAIDs and SASP and MTX.Throug five years of therapy and follow-up, to evaluate the clinical and radiographic efficacy,prognosis,and safety.Chi-square test,Fisher exact test and paired t-test were performed.Outcome:At baseline,there was no statistical difference of the main parameters between two groups(p>0.05).After treatment,the efficacy of symptoms,inflammatory index,and radiographic progression in treatment group are better than control group(p<0.05 ).The remission rate was 87%compared to 8.7%,and the incidence of AS was 4.0%compared to 60.9%between treatment group and control group(p<0.05),there was no significant difference in the growth and development,adverse effects,and tolerance between two groups(p>0.05).Conclusion:Early combination therapy with methotrexate(MTX) and sulfasalazine(SASP) in ERA can get better remission of disease,prevention of radiographic progression,well tolerance,and less adverse effects to children.更多还原