鞘内联合注射甲氨蝶呤加地塞米松治疗狼疮中枢受累

New therapeutic approach to central nervous system involvement in systemic lupus erythematosus:intrathecal injection with methotrexate plus dexamethasone

目的 探讨鞘内联合注射甲氨蝶呤加地塞米松在治疗系统性红斑狼疮 (SLE)中枢神经系统 (CNS)病变中的作用。方法 对 2 4例常规剂量糖皮质激素治疗无效的CNS、SLE患者予鞘内联合注射甲氨蝶呤加地塞米松各 10～ 2 0mg ,对其临床疗效及副作用进行观察 ,并对鞘内注射治疗前后CNS、SLE住院死亡率进行比较。结果 2 2例CNS、SLE临床症状体征缓解 ,有效率 91 7% ;鞘内注射前脑脊液压力、蛋白及白细胞分别为 (2 0 2± 15 5 )mmH2 O、(145 2± 876 )mg/L及 (2 5 1± 14 3)× 10 6/L ,而鞘内注射后分别下降为 (12 9± 10 8)mmH2 O、(6 0 8± 383)mg/L及 (6 8± 2 1)× 10 6/L ,P均 <0 0 5 ;4例出现一过性不良反应 ,如双下肢烧灼感、头痛及一过性大小便失禁 ;鞘内注射前后CNS、SLE住院死亡率分别为 30 2 (2 9/ 96例 )及 4 0 % (3/ 75例 ) ,P <0 0 1。结论 鞘内联合注射甲氨蝶呤加地塞米松是治疗CNS、SLE的一种有效方法 ,值得进一步临床研究。

Objective To investigate the effect of intrathecal injection (IT) with methotrexate (MTX) plus dexamethasone (DXM) in treating central nervous system involvement in systemic lupus erythematosus (CNS SLE).Methods Twenty four CNS SLE patients that were refractory to conventional steroid therapy were selected for IT with MTX 10～20 mg plus DXM 10～20 mg.The effect and adverse reaction of IT were closely observed and the mortality rates of CNS SLE before and after IT were compared.Results The symptoms and signs of 22(91 7%) CNS SLE patients improved considerably.Cerebrospinal fluid pressure,protein and WBC levels declined from (202±155) mm H 2O,(1 452±876) mg/L and (25 1±14 3)×10 6/L to (129±108) mm H 2O,(608±383) mg/L and (6 8±2 1)×10 6/L respectively ( P <0 05);Transient adverse reactions were observed in 4 patients,1 with burning sensation of lower limbs,2 with headache and 1 with sphincter incontinence.The mortality rates of CNS SLE before and after the application of IT were 30 2%(29/96) and 4 0%(3/75) respectively ( P <0 01).Conclusion IT with MTX plus DXM is a new promising method in treating CNS SLE and deserves further investigation.