目的 观察不同剂量糖皮质激素(GC)联合治疗对早期类风湿关节炎患者临床症状、红细胞沉降率(ESR)水平的影响。 方法 选择我院收治的早期风湿性关节炎患者90例为研究对象，依据GC剂量，将其分为大剂量组(n=30，给予大剂 量泼尼龙松+甲氨蝶呤+来氟米特治疗)、中剂量组(n=30，给予中等剂量泼尼龙松+甲氨蝶呤+来氟米特治疗)和小剂 量组(n=30，给予小剂量泼尼龙松+甲氨蝶呤+来氟米特治疗)，观察比较其临床症状、炎性因子水平及不良反应。 结果 治疗后，三组关节压痛数、关节肿胀数及DAS28评分按照低剂量、中剂量、大剂量顺序依次降低(P＜0.05)， 且大剂量组治疗后的上述指标均低于中剂量组和低剂量组(P＜0.05)；治疗后，三组ESR、RF、CRP、IL-6水平按照 低剂量、中剂量、大剂量顺序依次降低(P＜0.05)，且大剂量组治疗后的上述炎性因子指标均低于中剂量组和低剂 量组(P＜0.05)；大剂量组23.33%(7/30)的不良反应发生率与中剂量组的20.00%(6/30)、小剂量组的16.67%(5/30) 比较，差异无统计学意义(P＞0.05)。结论 大剂量GC药物抗炎效果更佳，可快速、有效降低早期RA患者关节炎症反 应，且不增加不良反应。

Objective To observe the effects of combined therapy of different doses of glucocorticoids(GC) on clinical symptoms and erythrocyte sedimentation rate(ESR) in patients with early rheumatoid arthritis. Methods 90 patients with early rheumatoid arthritis admitted to our hospital were selected as subjects. According to the GC dose, they were divided into high dose group(n=30, given high dose of prednisolone+methotrexate+leflunomide), middle dose group(n=30, middle dose of prednisolone+methotrexate+leflunomide) and low dose group(n=30, given low dose of prednisolone+ methotrexate+leflunomide). The clinical symptoms, inflammatory factors levels and adverse reactions were observed and compared. Results After treatment, the tender joint count, joint swelling count and DAS28 score in the three groups were decreased in turn according to the order of low dose, middle dose and high dose(P<0.05), and the above indexes after treatment in high dose group were lower than those in middle dose group and low dose group(P<0.05). After treatment, the levels of ESR, RF, CRP and IL-6 in the three groups were decreased in turn according to the order of low dose, middle dose and high dose(P<0.05), and the above inflammatory factors indexes after treatment in high dose group were lower than those in middle dose group and low dose group(P<0.05). There was no significant difference in the incidence rate of adverse reactions among high dose group, middle dose group and low dose group [23.33% (7/30) vs 20.00% (6/30) vs 16.67% (5/30)](P>0.05). Conclusion High dose GC drugs have better antiinflammatory effects, and they can quickly and effectively reduce joint inflammatory reactions in patients with early RA, and it will not increase the adverse reactions.