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目的比较小剂量肾上腺糖皮质激素(GC)与生物制剂益赛普的短期应用,在类风湿性关节炎(RA)达标治疗中的效果。方法 48例RA患者随机分为小剂量GC治疗组(28例,给予免疫抑制剂联合小剂量GC),益赛普治疗组(20例,给予免疫抑制剂联合益赛普)。24周后将GC和益赛普分别减量至停用,分别于开始治疗后第4、12、24周和药物开始减量后的第4、12、24周评价其病情活动。并在开始治疗后第24周时评价两组患者的达标情况。并比较两组治疗前、治疗后24、48周的骨密度情况和用药期间的不良反应。结果在治疗后第1个月益赛普治疗组DAS28评分较小剂量GC组有明显下降,在之后的几个月里,两组DAS28评分的变化无明显差异。用这两组方案治疗的RA患者达标率无明显差别。骨密度值与治疗前相比,GC组与益赛普组比较有明显下降。结论小剂量GC联合慢作用药物与益赛普联合慢作用药物的短期应用,在疗效、达标治疗及不良反应方面均无明显差异。但GC治疗组比益赛普组患者腰椎骨密度有所下降。
Objectives To compare the short-term effects of low-dose glucocorticoid (GC) with biologic agent izaprine in the treatment of patients with rheumatoid arthritis (RA). Methods Forty-eight patients with RA were randomly divided into low-dose GC treatment group (28 cases, immunosuppressant combined with low-dose GC), Yisipu treatment group (20 cases, immunosuppressive agents combined with Yisipu). After 24 weeks, GC and Ipreduca were respectively disabled and disabled. The disease activity was assessed at weeks 4, 12, and 24 after the start of treatment and at weeks 4, 12 and 24 after the drug started to decrease. Patients in both groups were evaluated for compliance at the 24th week after initiation of treatment. The bone mineral density (BMD) at 24 and 48 weeks after treatment and the adverse reactions during the treatment were compared between the two groups. Results In the first month after treatment, the DAS28 score in the prednisone-treated group was significantly lower than that in the low-dose GC group. There was no significant difference in the DAS28 scores between the two groups in the following months. RA patients treated with these two programs no significant difference in compliance rates. Compared with the pre-treatment group, the bone mineral density decreased significantly in the GC group and the Yisaipu group. Conclusion The short-term application of low-dose GC combination with slow-acting drugs combined with iisalapride has no significant difference in curative effect, standard treatment and adverse reactions. However, the BMD of lumbar spine in GC-treated patients was lower than that in patients treated with besylate.