甲氨喋呤治療強直性脊柱炎的系統評價△_《中國循證醫學雜志》

作者：

林珺芳 ¹ ,  陳君敏 ¹ , 劉超 ²

1. 福建醫科大學附屬第一醫院風濕科（福州 350005）2. 河北醫科大學附屬第一醫院（石家莊 050031）;

關鍵詞：

甲氨喋呤強直性脊柱炎系統評價

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目的　評價甲氨喋呤（MTX）治療強直性脊柱炎（AS）的療效和副作用。
方法　計算機檢索 CENTRAL（Cochrane圖書館2005年第4期）、MEDLINE （1966～2005.11）、 EMbase（1980～2005.11）和 CINAHL（1982～2005.11）中的相關文獻，語種不限。納入所有MTX治療AS的隨機對照試驗和半隨機對照試驗，由兩名評價員獨立納入試驗和提取資料，并對其方法學質量進行評價。對符合納入標準的研究采用RevMan 4.2軟件進行Meta分析。
結果　共納入3個隨機對照試驗（n=116例）。Meta分析結果顯示，在改善身體功能、疼痛、脊柱活動度、外周關節/附著點疼痛、腫脹和壓痛、脊柱放射學變化、以及患者和醫生總體評價等主要結局指標方面，用與不用MTX比較，其差異無統計學意義。唯一的陽性結果是，有1個試驗顯示MTX組與安慰劑組相比，緩解率提高36%[RR 3.18，95% CI（1.03，9.79）]。該試驗中判定緩解的根據是綜合晨僵、身體健康狀況、Bath強直性脊柱炎活動指數（BASDAI）、Bath強直性脊柱炎功能指數（BASFI）、健康評定問卷（HAQ-S）、患者和醫生總體評價等7項指標的變化值，而對所有這些指標的終點值進行分析發現，沒有一項顯示MTX組與安慰劑組之間有統計學差異。因此，MTX治療強直性脊柱炎是否有益，值得懷疑。納入的試驗沒有報告MTX有嚴重的副作用。
結論　目前尚沒有足夠的證據顯示MTX對AS患者有益。還需要開展更多高質量、大樣本和更長療程的隨機對照試驗，驗證MTX治療強直性脊柱炎的療效和安全性。

引用本文： 林珺芳,陳君敏,劉超. 甲氨喋呤治療強直性脊柱炎的系統評價△. 中國循證醫學雜志, 2007, 07(4): 260-266. doi: 復制

1.	American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis. Arthritis & Rheumatism, 2002, 46(76): 328-346.
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4.	Olivieri I, van Tubergen A, Salvarani C, et al. Seronegative spondyloarthritides. Best Practice & Research Clinical Rheumatology, 2002, 16(92): 723-739.
5.	van der Heijde D, van der Linden S, Ballamy N, et al. Which domains should be included in a core set for endpoints in ankylosing spondylitis? Introduction to the ankylosing spondylitis module of OMERACT IV. The Journal of Rheumatology, 1999, 26(76): 495-497.
6.	van der Heijde D, Braun J, McGonagle D, et al. Treatment trials in ankylosing spondylitis: current and future considerations. Annals of the Rheumatic Diseases, 2002, 61(Suppl III):iii24-iii32.
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8.	Roychowdhury B, Bintley-Bagot S, Bulgen DY, et al. Is methotrexate effective in ankylosing spondylitis?. Rheumatology (Oxford), 2002, 41( ): 1330-1332.
9.	Gonzalez-Lopez, Garcia-Gonzalez A, Vazquez-Del-Mercado M, et al. Efficacy of methotrexate in ankylosing spondylitis: A randomized, double blind, placebo controlled trial. The Journal of Rheumatology, 2004, 31(8): 1568-1574.
10.	Xie RL, Li XH, Kang XT. Methotrexate in conjunction with meloxicam for treating ankylosing spondylitis: a clinical observation of the efficacy and safety. Academic Journal of the First Medical College of PLA, 2003, 23(5): 460-462.
11.	Anderson JJ, Baron G, van der Heijde D, et al. Ankylosing spondylitis assessment group preliminary definition of short-term improvement in ankylosing spondylitis. Arthritis & Rheumatism, 2001, 44(8): 1876-1886.
12.	Brandt J, Listing J, Sieper J, et al. Development and preselection of criteria for short term improvement after anti-TNFa treatment in ankylosing spondylitis. Annal of Rheumatic Disseases, 2004, 63(129): 1438-1444.
13.	Biasi D, Carletto A, Caramaschi P, et al. Efficacy of methotrexate in the treatment of ankylosing spondylitis: a three-year open study. Clinical Rheumatology, 2000, 19(64): 114-117.
14.	Clavaguera MT, Juanola X, Narvaez FJ. Methotrexate in the treatment of ankylosing spondylitis. British Journal of Rheumatology, 1998, 37(Supplement 1): 45.
15.	Creemers MC, Franssen MJ, van de Putte LB, et al. Methotrexate in severe ankylosing spondylitis: an open study. Journal of Rheumatology, 1995, 22(6): 1104-1107.
16.	Handler RP. Favourable results using methotrexate in the treatment of patients with ankylosing spondylitis. Arthritis & Rheumatism 1989, 32: 234.
17.	Kirnap M, Demir H, Sigan YT, et al. Efficacy and side effects of low dose methotrexate treatment in the patients with ankylosing spondylitis. Journal of Rheumatology, 2000, 27(Suppl 59): 57.
18.	Ostendorf B, Specker C, Schneider M. Methotrexate lacks efficacy in the treatment of severe ankylosing spondylitis compared with rheumatoid and psoriatic arthritis. Journal of Clinical Rheumatology 1998, 4(25): 129-136.
19.	Sampaio-Barros PD, Costallat LT, Bertolo MB, et al. Methotrexate in the treatment of ankylosing spondylitis. Scandinavian Journal of Rheumatology, 2000, 29(36): 160-162.

1. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis. Arthritis & Rheumatism, 2002, 46(76): 328-346.
2. Dougados M, Revel M, Khan MA. Spondyloarthropathy treatment: progress in medical therapy. Bailliere’s clinical rheumatology, 1998, 12( ): 717-736.
3. Suarez-Almazor ME, Belseck E, Shea B, et al. Methotrexate for treating rheumatoid arthritis. In: The Cochrane Library, 2, 2003. Oxford: Update Software. 10.1002/14651858.CD000957.
4. Olivieri I, van Tubergen A, Salvarani C, et al. Seronegative spondyloarthritides. Best Practice & Research Clinical Rheumatology, 2002, 16(92): 723-739.
5. van der Heijde D, van der Linden S, Ballamy N, et al. Which domains should be included in a core set for endpoints in ankylosing spondylitis? Introduction to the ankylosing spondylitis module of OMERACT IV. The Journal of Rheumatology, 1999, 26(76): 495-497.
6. van der Heijde D, Braun J, McGonagle D, et al. Treatment trials in ankylosing spondylitis: current and future considerations. Annals of the Rheumatic Diseases, 2002, 61(Suppl III):iii24-iii32.
7. Altan L, Bingol U, Karakoc Y, et al. Clinical investigation of methotrexate in the treatment of ankylosing spondylitis. Scandinavian Journal of Rheumatology, 2001, 30(5): 255-259.
8. Roychowdhury B, Bintley-Bagot S, Bulgen DY, et al. Is methotrexate effective in ankylosing spondylitis?. Rheumatology (Oxford), 2002, 41( ): 1330-1332.
9. Gonzalez-Lopez, Garcia-Gonzalez A, Vazquez-Del-Mercado M, et al. Efficacy of methotrexate in ankylosing spondylitis: A randomized, double blind, placebo controlled trial. The Journal of Rheumatology, 2004, 31(8): 1568-1574.
10. Xie RL, Li XH, Kang XT. Methotrexate in conjunction with meloxicam for treating ankylosing spondylitis: a clinical observation of the efficacy and safety. Academic Journal of the First Medical College of PLA, 2003, 23(5): 460-462.
11. Anderson JJ, Baron G, van der Heijde D, et al. Ankylosing spondylitis assessment group preliminary definition of short-term improvement in ankylosing spondylitis. Arthritis & Rheumatism, 2001, 44(8): 1876-1886.
12. Brandt J, Listing J, Sieper J, et al. Development and preselection of criteria for short term improvement after anti-TNFa treatment in ankylosing spondylitis. Annal of Rheumatic Disseases, 2004, 63(129): 1438-1444.
13. Biasi D, Carletto A, Caramaschi P, et al. Efficacy of methotrexate in the treatment of ankylosing spondylitis: a three-year open study. Clinical Rheumatology, 2000, 19(64): 114-117.
14. Clavaguera MT, Juanola X, Narvaez FJ. Methotrexate in the treatment of ankylosing spondylitis. British Journal of Rheumatology, 1998, 37(Supplement 1): 45.
15. Creemers MC, Franssen MJ, van de Putte LB, et al. Methotrexate in severe ankylosing spondylitis: an open study. Journal of Rheumatology, 1995, 22(6): 1104-1107.
16. Handler RP. Favourable results using methotrexate in the treatment of patients with ankylosing spondylitis. Arthritis & Rheumatism 1989, 32: 234.
17. Kirnap M, Demir H, Sigan YT, et al. Efficacy and side effects of low dose methotrexate treatment in the patients with ankylosing spondylitis. Journal of Rheumatology, 2000, 27(Suppl 59): 57.
18. Ostendorf B, Specker C, Schneider M. Methotrexate lacks efficacy in the treatment of severe ankylosing spondylitis compared with rheumatoid and psoriatic arthritis. Journal of Clinical Rheumatology 1998, 4(25): 129-136.
19. Sampaio-Barros PD, Costallat LT, Bertolo MB, et al. Methotrexate in the treatment of ankylosing spondylitis. Scandinavian Journal of Rheumatology, 2000, 29(36): 160-162.

《中國循證醫學雜志》

甲氨喋呤治療強直性脊柱炎的系統評價△

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《中國循證醫學雜志》

甲氨喋呤治療強直性脊柱炎的系統評價△

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