鞘内注射甲氨蝶呤、地塞米松治疗神经精神狼疮的随访研究

Follow of pulse therapy of methylprednisolone combinded with intrathecal methotrexate and dexamethasone on patiens with neuropsychiatric systemic lupus erythematosus

目的观察两种方法治疗神经精神狼疮(NPSLE)的远期疗效,并探讨NPSLE复发的危险因素。方法36例NPSLE随机分成两组,两组均静脉冲击甲泼尼龙冲(MP)1g3d,实验组联合鞘内注射甲氨蝶呤(MTX)10mg和地塞米松(DXM)10mg每周1次,≤3次。对照组每周应用环磷酰胺(CTX)0.4g/1次,≤3次。观察两组1年内NPSLE的复发率和NPSLE复发时与未复发患者随访6个月和1年时系统性红斑狼疮活动指数(SLEDAI)△(不计神经精神评分)和泼尼龙维持量差异有无统计学意义。结果1年内实验组18例患者有2例复发,对照组16例有8例复发,实验组显著低于对照组。NPSLE复发时与未复发患者随访6个月、1年时系统性红斑狼疮活动指数(SLEDAI)和泼尼龙维持量差异无统计学意义。结论静脉冲击MP联合鞘内注射MTX和DXM治疗NPSLE复发率低;NPSLE复发与SLEDAI和泼尼龙维持量无关。

Objective To investigate long term outcome of pulse therapy of methylprednisolone(MP)combinded with intrathecal methotrexate(MTX)and dexamethasone(DXM)on patiens with neuro-psychiatric systemic lupus erythematosus(NPSLE)and risk factor of relapse of NPSLE.Methods 36 patients with NPSLE were randomly divided into 2 groups,2 groups were treated with pulse therapy of MP 1g for 3 days,one combinded with intrathecal(IT)MTX10 mg and(DXM)10 mg once a week,another combinded with intravenous cyclophosphamide(CTX)0.4 g per week,two ways were no more than 3 times.Results 2 of eighteen patiens in experimental groups and eight of sixteen patiens in control groups relapsed in one year.SLEDAI and dose of prednisone had no signifficent difference between patiens when they relapsed and patiens had not relapsed while they had been followed for six months and one year.Conclusion Patiens with NPSLE treated with pulse therapy of MP combinded with IT MTX and DXM has less relapse rate than that treated with pulse therapy of MP combinded with intravenous CTX.Relapse of NPSLE hase no related to SLEDAI and dose of prednisone.