标题：不同剂量甲氨蝶呤联合叶酸治疗类风湿关节炎的疗效与安全性评估

      作者：李晓英，杨丹丹，黄俊俏，朱征西    (百色市人民医院风湿免疫科，广西 百色 533000)

      卷次： 2017年28卷20期

      【摘要】 目的 评估不同剂量甲氨蝶呤(MTX)联合叶酸治疗类风湿关节炎(RA)的疗效及其不良反应发生情况。方法 选择百色市人民医院2015年1月至2016年4月风湿免疫科收治的102例RA患者为研究对象，根据随机数表法分为A、B、C组，每组34例，分别给予MTX 7.5 mg/周，MTX 7.5 mg/周+叶酸5 mg/d及MTX 15 mg/周+叶酸5 mg/d治疗，疗程为6个月。比较三组患者治疗后的临床疗效、类风湿因子(RF)水平的变化及不良反应发生情况。结果 治疗后，A、B、C组三组患者血清RF水平均较治疗前明显下降(P<0.05)，但是三组间比较差异无统计学意义(P>0.05)；A、B、C组三组患者治疗总有效率分别为76.47%、79.41%、88.24%，差异无统计学意义(P>0.05)；B组不良反应发生率为8.82%，明显低于A组的29.41%和C组的23.53%，差异均有统计学意义(P<0.05)。结论 小剂量MTX (7.5 mg/周)治疗类风湿关节炎具有较好的临床疗效，且其不良反应发生率相对较低，加用叶酸治疗可进一步降低MTX的不良反应。
      【关键词】 类风湿关节炎；甲氨蝶呤；叶酸；不良反应
      【中图分类号】 R593.22 【文献标识码】 A 【文章编号】 1003—6350（2017）20—3291—03

Efficacy and side effects of different doses of methotrexate combined with folic acid in treatment of rheumatoidarthritis.
LI Xiao-ying, YANG Dan-dan, HUANG Jun-qiao, ZHU Zheng-xi. Department of Rheumatology andImmunology, People's Hospital of Baise, Baise 533000, Guangxi, CHINA
【Abstract】 Objective To investigate the efficacy and adverse effects of methotrexate (MTX) combined withfolic acid in the treatment of rheumatoid arthritis (RA). Methods A total of 102 RA patients treated in our hospitalfrom January 2015 to April 2016 were selected and divided into A, B, C group according to random number table, with34 patients in each group, which were respectively given MTX 7.5 mg/week, MTX 7.5 mg/week+folic acid 5 mg/d, andMTX 15 mg/week+folic acid 5 mg/d, for 6 months. The clinical efficacy, rheumatoid factor (RF) levels and adverse reac-tions were compared among the three groups. Results After treatment, the serum RF levels in A, B, C group were sig-nificantly decreased compared with before treatment (P<0.05), but there was no significant between-group difference inthe three groups (P>0.05). The effective rate in the three groups showed no significant difference (76.47% , 79.41% ,88.24%, respectively, P>0.05). The side effect rate in B group was 8.82%, significantly lower than 29.41% in A groupand 23.53% in C group (P<0.05). Conclusion The low dose MTX (7.5 mg/w) in the treatment of RA has good clinicalefficacy and relatively low incidence of adverse reactions, and combined application of folic acid can further reduce theadverse reaction of MTX.
      【Key words】 Rheumatoid arthritis; Methotrexate (MTX); Folic acid; Adverse reactions·论 著·doi:10.3969/j.issn.1003-6350.2017.20.008