甲氨蝶呤联合羟基氯喹对类风湿关节炎合并糖尿病患者糖化血红蛋白水平的影响

目的:观察类风湿关节炎(rheumatoid arthritis,RA)合并糖尿病(diabetes mellitus,DM)患者使用甲氨蝶呤(methotrexate,MTX)联合羟基氯喹(hydroxychloroquine,HCQ)治疗前后糖化血红蛋白(glycosylated hemoglobin,HbA1C)水平的变化。方法:通过回顾性分析,选取联合使用MTX+HCQ或单独使用MTX治疗的RA合并DM患者,且在治疗前及开始治疗12个月内分别至少有1次HbA1C值,记录其年龄、性别、诊断、体重指数、使用糖皮质激素情况。计算用药前到用药后12个月内HbA1C最低值的变化。结果:40例使用HCQ+MTX和45例使用MTX患者符合入选标准。两组间年龄、性别、体重指数、用药前HbA1C水平相似,MTX+HCQ组糖皮质激素使用比例(40.00%)比HCQ组更多(26.67%)(P=0.25)。MTX+HCQ组治疗后HbA1C有明显下降(0.42%,P=0.00),且MTX+HCQ组HbA1C降低幅度高于MTX组(0.42%,0.12%,P=0.02)。结论:与单独使用MTX相比,RA合并DM患者联合使用HCQ+MTX可明显降低HbA1C水平。

Effect of Methotrexate Combination Hydroxychloroquine Treatment on Glycosylated Hemoglobin Level in Rheumatoid Arthritis Patients with Diabetes

Objective:To examine the effect of methotrexate (MTX) combination hydroxychloroquine (HCQ) treatment on glycosylated hemoglobin (HbA1c) level in rheumatoid arthritis (RA) patients with diabetes mellitus (DM).Methods:We identified RA patients beginning treatment with either MTX+HCQ or MTX using retrospective analysis. The patients had a diagnosis of DM and at least one HbA1c measurement both before and within 12 months after initiation of treatment. We recorded age, sex, body mass index (BMI), disease diagnosis, DM medication, cumulative steroid use, HbA1c value before and after drug treatment.Results:We identified 40 patients taking HCQ+MTX and 45 patients taking MTX who met the inclusion criteria. There were no significant differences of age, sex, BMI and mean pretreatment HbA1c levels between two groups. More patients used glucocorticoid in MTX+HCQ group (40.00%) than in MTX group (26.67%) (P=0.25). The HbA1c value was significantly reduced after taking HCQ+MTX treatment. The change of HbA1c from pretreatment values to the lowest posttreatment values was 0.42% in HCQ+MTX group, compared with 0.12% in MTX group.Conclusion:HCQ+MTX treatment was associated with a significantly greater reduction in HbA1c as compared with MTX treatment in RA patients with DM.