目的 系统评价小剂量糖皮质激素(<15 mg/d)治疗类风湿性关节炎的远期疗效以及安全性.方法 检索小剂量糖皮质激素治疗类风湿性关节炎的随机临床试验结果.用Revman4.2软件对入选的文献进行Meta分析.结果 最终纳入14项研究,Meta分析结果:临床有效率的合并OR值为1.50,95%CI:1.18~1.92,P=0.001;骨关节有效率的合并OR值为0.87,95%CI:0.66~1.55,P=0.32;小剂量激素对Sharp评分影响的合并OR值为-5.84,95%CI:-6.73~-4.95,P＜0.000 01;对骨质侵蚀分数影响的合并OR值为-4.34,95%CI:-4.63~-3.99,P＜0.000 01;对关节狭窄分数影响的合并OR值为-1.03,95%CI:-1.31~-0.75,P＜0.000 01;对健康评定问卷(HAQ)评分和握力比较差异无统计学意义.结论 小剂量糖皮质激素治疗类风湿性关节炎远期疗效较好且不会引起不良反应.%Objective To evaluate the long term efficacy and satety of low dose prednisolone (＜15 mg daily) in comparison with placebo and nonsteroidal antiinflammatory drugs in patients with rheumatoid arthritis. Methods Searching clinical trials about treatment RA with low dose prednisolone. The data were analysed by Revman4. 2 software. Results 14 studies were included in the metaanalysis. Prednisolone group had a marked effect over control group on the rate of achievement of ACR 20% ,OR 1. 50(95%CI 1. 18 to 1. 92) ,P = 0. 001. Bone erosion and joint space narrowing were measured radiographically,OR 0. 87(95%CI 0. 66 to 1. 55) , P = 0. 32 ,Prednisolone group also had a greater effect than control group on Sharp scale,OR - 5. 84(95% CI - 6.73 to - 4. 95)and erosion score,OR -4.34(95% CI -4. 63 to -3.99) and joint space narrowing,OR- 1. 03(95% CI -1.31 to -0. 75) , whereas the difference in HAQ and grips trength was not significant. Conclusion Long term prednisolone in low doses is effective in the treatment of RA. In addition,it did not induce side-effects in the patients.
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