糖皮质激素治疗系统性红斑狼疮的剂量探讨

Exploration of Dosage of Glucocorticoid in Treatment of Systemic Lupus Erythematosus

目的探讨糖皮质激素治疗系统性红斑狼疮(SLE)的合理剂量。方法将2007年3月至2010年2月在深圳市第二人民医院风湿免疫科就诊的88例SLE患者,按照随机数字表法分为糖皮质激素高、中、低剂量组,观察并比较三组患者治疗后的疗效,血清血Ca、甲状旁腺激素(PHT)的水平以及骨密度变化。结果高、中剂量组患者的疗效显著高于低剂量组(P<0.05),高、中剂量组比较无统计学意义(P>0.05);治疗后,高剂量组患者血清Ca水平及Wards三角骨密度显著低于中、低剂量组(P<0.05),血清PHT水平显著高于中、低剂量组(P<0.05);高剂量组的骨损率显著高于中剂量组(χ2=4.504,P=0.034)和低剂量组(χ2=5.431,P=0.020),而中剂量组与低剂量组比较无统计学意义(χ2=0.119,P=0.730)。结论中剂量组的疗效近似于高剂量,但骨损伤率显著低于高剂量组,因此临床上可以以泼尼松累计剂量14 g作为SLE治疗的指导用量。

Objective To explore the appropriate dosage of glucocorticoid in treatment of systemic lu- pus erythematosusSLE）. Methods Total of 88 patients with SLE of Shenzhen Second People＇s Hospital in from Mar. 2007 to Feb. 2010 were randomly divided into 3 groups （ the high dose group, the middle dose group and the low dose group） according to the random number table method,the curative effect after treatment,serum blood calcium, PHT content and bone density were observed and compared. Results The curative effect of the high dose group and the middle dose group were higher than that of the low dose group（ P 〈0.05 ）, and there was no statistically significant difference between high dose group and middle dose group（ P 〉 0.05 ）. The blood Ca and Wards triangular bone density of high dose group were signifi- candy lower than middle dose group and low dose group（ P 〈0.05 ） ,the serum PHT was higher than them （ P 〈 0.05 ）. The bone damage rates of the high dose group was higher than middle dose group（ χ^2 = 4. 504, P = 0. 034） and the low dose group （χ^2 = 5.431,P = 0. 020）, while there was no statistically significant difference between middle dose group and low dose group （ χ^2 = 0. 119, P = 0. 730 ）. Conclusion The middle dose group has similar curative effect with the high dose group, but the bone damage rate was lower than the high dose group, so the cumulative dose of 14 g can be used as the guidance dosage of glucocorti- cold in treatment of SLE.