Objective To evaluate the efficacy and toxicity of methotrexate (MTX) in the treatment of ankylosing spondylitis (AS). Methods Randomized controlled trials (RCTs) were identified from CENTRAL (The Cochrane Library Issue 4, 2005); MEDLINE (1966 to November 2005); EMBASE (1980 to November 2005); CINAHL (1982 to November 2005). The quality of included trials was evaluated. Data were extracted by two reviewers independently using a specially designed extraction form. The Cochrane Collaboration’s RevMan 4.2 software was used for data analysis. Results Three trials involving 116 patients were included. One 12-month trial compared naproxen plus MTX with naproxen alone. Two 24-week trials compared different doses of MTX with placebo. No statistically significant differences were found for the primary outcome measures of physical function, pain, spinal mobility, peripheral joints/entheses pain, swelling and tenderness, changes in spine radiographs and patient and physician global assessment. The response rate in one trial showed statistically significant benefits of 36% in the MTX group compared with the placebo group (RR 3.18, 95% CI 1.03 to 9.79). This response rate was a composite index including assessment of morning stiffness, physical well-being, Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), health assessment questionnaire for spondyloarthropathies (HAQ-S), and physician and patient global assessment. However, no single outcome showed a statistically significant difference between the MTX and placebo groups when endpoint results were compared. Therefore, this benefit of MTX was questionable. No serious side effects were reported in these studies. Conclusions There is no enough evidence to show any benefit of MTX in the treatment of AS. High quality randomized controlled trials of longer duration and with larger sample size are needed to clarify the effect of MTX on AS.
目的:观察白芍总苷(TGP)联合甲氨喋呤(MTX)和柳氮磺吡啶(SASP)治疗强直性脊柱炎(AS)疗效和安全性。方法:58例符合强直性脊柱炎标准的患者随机纳入2组:治疗组:29例,口服白芍总苷+甲氨喋呤+柳氮磺吡啶;对照组:29例,口服甲氨喋呤+柳氮磺吡啶,两组疗程均为3月。结果:经3月治疗,两组间Schober实验、胸廓扩张度、晨僵持续时间、血沉(ESR)及C反应蛋白(CRP)等5项指标较治疗前均显著降低(Plt;0.01),但治疗组上述指标改善值优于对照组,差异分别有显著意义(Plt;0.05)或极显著意义(Plt;0.01);治疗组不良反应发生率明显少于对照组(Plt;0.05)。结论:白芍总苷联合甲氨喋呤和柳氮磺吡啶是治疗强直性脊柱炎安全有效方法。
ObjectiveTo compare the curative effect of three therapeutic strategies for cesarean scar pregnancy (CSP). MethodsBetween January 2009 and December 2013, 208 patients with CSP underwent intramuscular methotrexate alone (group A, n=72), transvaginal ultrasound monitoring after embryo sac strangulation after injection of methotrexate (group B, n=70) and uterine arterial chemoembolization therapy monitoring after hysteroscopy surgery (group C, n=66). We studied their clinical data retrospectively. The preoperative treatment interval, the hospitalization days, intraoperative bleeding, time of blood β-HCG to normal level and hospitalization costs were compared between the groups. ResultsThe preoperative treatment interval, hospitalization days, intraoperative bleeding, and time of blood β-HCG to normal level of group C were significantly better than those of group A and B (P<0.05), while the hospitalization cost of the three groups were not statistically signficant (P>0.05). ConclusionAs a treatment for CSP, uterine artery chemoembolization is a safe and effective method, and it has the advantages of short hospitalization time, less intraoperative bleeding and high fertility preservation. It is worth application in clinical medicine.