研究长期甲氨蝶呤（MTX）治疗硫唑嘌呤（AZA）干预无效型溃疡性结肠炎（UC）的疗效。

选取济宁医学院92例AZA干预无效型UC患者为研究对象，按随机数表法分为对照组和观察组，每组各46例，观察组予以MTX肌肉注射治疗，持续治疗1年，对照组予以MTX肌肉注射治疗，持续治疗半年，后改安慰剂继续治疗半年。比较两组临床疗效差异，分析两组血红蛋白（HB）、白蛋白（ALB）、血沉（ESR）、C-反应蛋白（CRP）、血小板（PLT）水平，同时了解两组不良反应发生率。

两组治疗半年后临床疗效差异无显著统计学意义（χ²=0.045；P>0.05）。观察组治疗1年总有效率高于观察组治疗半年（χ²=11.683，P<0.05），也高于对照组治疗1年（χ²=17.692，P<0.05）。观察组HB、ALB指标在治疗前（t=4.181，4.599）、治疗半年（t=7.950，9.756）、治疗1年后（t=3.635，5.180），均成升高趋势（均P<0.05），ESR、CRP、PLT在治疗前（t=10.789，16.959，62.326）、治疗半年（t=22.270，23.002，75.209）、治疗1年后（t=16.339，9.553，11.515）均呈降低趋势（均P<0.05）。对照组治疗半年（t=4.465，4.405）及治疗1年（t=3.942，3.321）HB、ALB均明显高于治疗前，ESR、CRP、PLT治疗半年（t=10.743，17.248，61.852）及治疗1年（t=9.670，15.893，60.567）均明显低于治疗前（均P<0.05），而治疗半年与治疗1年各指标比较差异无显著统计学意义（t=0.496，1.150，1.200，0.233，0.312；均P>0.05）。治疗1年后，观察组HB、ALB均明显高于对照组（t=3.893，6.240；均P<0.05），ESR、CRP、PLT均明显低于对照组（t=17.009，9.971，11.662；均P<0.05）。两组不良反应发生率差异无统计学意义（χ²=1.848，P>0.05）。

长期MTX用于AZA干预无效UC临床疗效佳，并可改善体内营养状况及凝血功能，同时能降低体内炎症反应，缓解病情，安全性高，具有较好的临床应用价值。

To study the efficacy of long-term methotrexate (MTX) in the treatment of ulcerative colitis (UC) with azathioprine (AZA) ineffective intervention.

Ninety-two patients with UC ineffective in the treatment of AZA, were randomly divided into two groups, forty-six cases in each group. The control group was given intramuscular injection of MTX for one year. The control group was treated with placebo for half a year after having finished intramuscular injection of MTX for six months. We Compare the differences of clinical efficacy in two groups, and analyze the level of hemoglobin (HB), albumin (ALB), blood sink (ESR), C-reactive protein (CRP), platelet (PLT) in two groups, and learn the incidence of adverse reactions in the two groups.

There was no significant difference in clinical curative effect between the two groups after six months (χ²=0.045; P>0.05).The total effective rate in the observation group after one year was higher than that for six months and that in control group (χ² = 11.683 and 17.692 respectively; P<0.05). The levels of HB and ALB were increased, and CRP, ESR and PLT were decreased during the treatment (t=4.181, 4.599, 10.789, 16.959, 62.326, 7.950, 9.756, 22.270, 23.002, 75.209, 3.637, 5.180, 16.339, 9.553, 11.515 respectively; P<0.05).The levels of HBsAg and ALT were significantly higher in the control group than those before treatment, and the levels of CRP, ESR and PLT were significantly lower than those before treatment (t=4.465, 4.405, 10.743, 17.248, 61.852, 3.942, 3.321, 9.670, 15.893, 60.567 respectively, P<0.05).There was no significant difference between the six months of treatment and the treatment for 1 year (t=0.496, 1.150, 1.200, 0.233, 0.312 respectively, P>0.05). After 1 year of treatment, HB and ALB in the observation group were significantly higher than those in the control group, CRP, ESR and PLT were significantly lower than those in the control group (t=3.893, 6.240, 17.009, 9.971, 11.662 respectively, P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (χ²=1.848, P>0.05).

MTX treatment of UC, which is ineffective in the treatment of azathioprine (AZA), can improve the nutritional status of the body, coagulation function, and reduce the body′s inflammatory response. It can control the disease and has high safety with a good clinical value.