环磷酰胺冲击治疗类风湿关节炎肺间质病变的研究

Monthly Intravenous Pulse Cyclophosphamide for Rheumatoid Arthritis Associated Interstitial Lung Disease

目的评估大剂量环磷酰胺冲击治疗类风湿关节炎肺间质病变(RA-ILD)的疗效及安全性。方法将50例符合RA-ILD病例随机分为环磷酰胺治疗组和对照组,治疗组与对照组均应用来氟米特(爱若华)加一种非甾体消炎药治疗原发病,对照组应用柳氮磺吡啶作为治疗类风湿的联合用药。治疗组应用环磷酰胺800mg每月静脉应用6月,后改为800mg/每两月维持治疗,并与治疗后6月、12月分别评估肺间质病变的改善情况及不良反应发生情况。结果环磷酰胺治疗组患者治疗后6月、12月肺高分辨CT(HRCT)均有明显好转,病变面积减少,变化具有统计学意义(P<0.05),而肺功能则以弥散功能及肺总量变化明显P值均小于0.01,且治疗12月疗效更明显。对照组仅弥散功能改善有统计学意义。结论每月环磷酰胺冲击治疗RA-ILD具有较为肯定的疗效和安全性。

Objective To study the efficacy and safety of monthly intravenous pulse cyclophosphamide （IVCYC） therapy for rheumatoid arthritis associated interstitial lung disease （RA -ILD ）. Methods Total 50 cases came from our rheumatology department were diagnosised as RA - ILD,And all the patient were divided randomly into 2 groups,one was control group , only give treatment for RA, another was treatment group give monthly intravenous pulse cyclophosphamide （IVCYC） therapy, at 6 or 12 months evaluate the change of High Resolution CT （HRCT）and lung function test （LFT） and adverse drug reaction. Results In the control group, no improvement was seen for any endpoint at 6 months and only the percentage of predicted DLCO have little improvement at 12 months of followup. In the treatment group, at 6 or 12 months there was significant improvement in the percentage of HRCT, as well as in the percentage of predicted TLC, the percentage of predicted DLCO. Conclusion Monthly intravenous pulse cyclophosphamide may have positive effects in treatment of RA - ILD.