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目的 探讨尼美舒利与甲氨蝶呤 (MTX)组成的联合方案治疗成人斯蒂尔病 (AOSD)是否优于传统依靠激素的治疗方法。方法 1996— 2 0 0 0年诊治的AOSD 6 8例连续性病人 ,随机分为 :试验组 35例 ,用尼美舒利与MTX联合治疗 :对照组 33例 ,采用传统的大剂量激素治疗。结果 用药 2 4h内体温恢复正常者 ,试验组有 2 4例(74 3% ) ,而对照组仅 9例 (2 7 3% ) ,差异有非常显著性 (χ2 =3 887,P =0 0 0 0 1) ;用药 1周内体温恢复正常者 ,试验组有 2 8例 (80 0 % ) ,而对照组仅 19例 (5 7 6 % ) ,差异有显著性 (χ2 =2 0 0 0 ,P =0 0 4 5 5 )。两组病人体温恢复正常的时间经Log rank检验 ,差异有显著性 (χ2 =6 10 ,P =0 0 135 )。试验组近 2 0 %的病人在随访中再次发热 ,而对照组超过 5 0 % ,经Log rank检验 ,两组差异有显著性 (χ2 =4 36 ,P =0 0 36 8)。治疗后 3个月和 6个月比较 ,试验组血沉、C反应蛋白、血白细胞和血清铁蛋白下降比对照组明显 ,两组间差异具有非常显著性 ,P值均 <0 0 0 1。副反应 ,试验组 35例全部出现多汗 ,对照组仅 18例 ;试验组 2例肝功能损害 ,对照组 1例 ;对照组 2例带状疱疹 ,而试验组无。结论 尼美舒利与MTX组成的联合方案 ,治疗AOSD优于传统依靠激素的疗法 ,值得临床试用?
Objective To investigate whether the combination of nimesulide and methotrexate (MTX) is superior to the traditional hormone-dependent treatment of adult patients with Still’s Disease (AOSD). Methods A total of 68 consecutive patients with AOSD diagnosed from 1996 to 2000 were randomly divided into experimental group (n = 35) and nimesulide combined with MTX (n = 33). The control group received conventional high-dose hormone therapy. Results The body temperature returned to normal within 24 hours after treatment, 24 cases (74.3%) in the test group and 9 cases (27.3%) in the control group, the difference was significant (χ2 = 3 887, P = 0 0 There were 28 cases (80%) in the test group and 19 cases (57.6%) in the control group, the difference was significant (χ2 = 2000 , P = 0 0 4 5 5). Two groups of patients returned to normal temperature by Log rank test, the difference was significant (χ2 = 6 10, P = 0 0 135). Nearly 20% of the patients in the test group re-experienced fever at follow-up, while the control group was over 50%. Log rank test showed significant difference between the two groups (χ2 = 4 36, P = 0 0 368). Compared with the control group, the levels of erythrocyte sedimentation rate, C-reactive protein, white blood cell and serum ferritin in the experimental group were significantly lower than those in the control group at 3 months and 6 months after treatment. The differences between the two groups were significant (P <0.01). Side reactions, all 35 cases of experimental group sweating, the control group, only 18 cases; experimental group 2 cases of liver dysfunction, control group, 1 case; control group, 2 cases of shingles, while the experimental group without. Conclusion Nimesulide and MTX combination of programs, treatment of AOSD superior to traditional hormone therapy, it is worth clinical trial?