系统性红斑狼疮环磷酰胺冲击治疗的最佳间期探讨

ASTUDYONINTERVALOFINTRAVENOUSCYCLOPHOSPHAMIDEPULSEINTREAT┐MENTOFSEVERESYSTEMICLUPUSERYTHEMATOSUS

为了解系统性红斑狼疮（ＳＬＥ）经环磷酰胺冲击治疗的最佳间期，将５２例重症ＳＬＥ患者随机分成两组，分别给予每２周和４周１次环磷酰胺冲击治疗（ＩＶ－ＣＴＸ），每次１５ｍｇ／ｋｇ，同时口服泼尼松。结果，间期２周组起效时间显著比４周组快；病情缓解率也是２周组显著高于４周组；病情活动性积分下降５０％时，两组ＣＴＸ累积量差异无显著性。４周组中５例（１９．２％）治疗过程中因病情加重，改为２周１次后得到控制，而２周组则有６例（２３．１％）因白细胞下降需将冲击间期延长为４周；两组副反应及其发生率无统计学差异。结果提示，在重症ＳＬＥ治疗初期，ＩＶ－ＣＴＸ每２周１次有利于加速病情缓解，提高疗效，但治疗过程中应注意观察血象，病情控制后改为４周以至３个月１次治疗。

Theaimofthisstudywastocomparetheclinicaleficacyandadverseefectsofintravenouscyclophosphamidepulsetherapybetwen2-weekand4-weekintervalsinthetreatmentofseveresystemiclupuserythematosus.52patientswereinvolvedinthestudyandwereequalydividedintotwogroups.Thepulseintervalswere2weeksforgroupⅠand4weeksforgroupⅡ.Eachpulsedoseofcyclophosphamidewas15mg/kg.Everypatienttookprednisone1mg/kgdailyforfirst8weeksandthentapered.Mostofdis-easeindicesrecoveredquickeringroupⅠthaningroupⅡ.Thegroupwithshortintervalwasbeterthanthatoflongoneontotaleficacyandremisionrate.Thecyclophosphamidecumulativedoseswerenotdif-ferentbetweentwogroupsasdiseaseactivityindexdropped50%.Thepulseintervalhadtobepro-longedfrom2weeksto4weekstosixpatientsingroupⅠ(23.1%)becauseofleukopenia,andbeshor-tenedfrom4weksto2weekstofivecasesingroupⅡ(19.2%)becauseofineficacy.Therewasnosta-tisticaldifer-enceinadverseefectsbetweentwogroups.Intravenouscyclophosphamidepulsetherapywithtwo-weeksintervalisadvantageoustorecoveryofseveresystemiclupuserythematosusprovidedbloodtestpriortoeachpulse.Wesuggestthatpulseintervalshouldbeindividualized.