鞘内注射联合冲击疗法治疗系统性红斑狼疮脑病的疗效与安全性评价

Evaluation of the efficacy and safety of intrathecal injection combined with pulse therapy in the treatment of systemic lupus erythematosus encephalopathy

目的研究并分析地塞米松以及甲氨蝶呤鞘内注射联合甲基强的松龙冲击疗法治疗系统性红斑狼疮的疗效以及安全性。方法收集于2014年9-2018年8月在河北北方学院附属第一医院确诊为系统性红斑狼疮性脑病的100例患者作为研究对象,采用随机数字表法将其分为两组,每组各50例。其中对照组仅接受甲基强的松龙冲击治疗,观察组接受地塞米松以及甲氨蝶呤鞘内注射联合甲基强的松龙冲击疗法治疗,比较两组患者脑脊液变化、细胞因子水平、临床疗效良反应以及病死率。结果接受治疗后,两组患者的脑脊液压力、总蛋白、白细胞较治疗前均有明显改善,并且观察组患者显著优于对照组(P<0.05);观察组的治疗总有效率为96.00%,对照组的治疗总有效率为78.00%,观察组明显高于对照组(P<0.05);接受治疗后,两组患者的肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、胸腺活化调节趋化因子(TARC)、干扰素诱生蛋白-10(IP-10)等细胞因子的水平较治疗前均有明显改善,并且观察组患者显著优于对照组(P<0.05);观察组治疗后未出现高血压、消化道出血、感染等不良反应,对照组治疗后并发上消化道出血1例,肺部感染3例,不良反应发生率为8.00%,两组差异具有统计学意义(P<0.05);随访12个月内,观察组患者复发率为22.00%,对照组患者复发率为34.00%,观察组明显低于对照组(P<0.05)。结论地塞米松以及甲氨蝶呤鞘内注射联合甲基强的松龙冲击疗法能够有效改善系统性红斑狼疮脑病患者的脑脊液环境,调节局部细胞因子水平,缓解临床症状,疗效明确,不良反应少,值得临床推广应用。

Objective To study and analyze the efficacy and safety of dexamethasone and methotrexate intrathecal injection combined with methylprednisolone pulse therapy in the treatment of systemic lupus erythematosus.Methods A total of 100 patients with systemic lupus erythematosus encephalopathy diagnosed in the First Affiliated Hospital of Hebei North University from September 2014 to August 2018 were randomly divided into two groups with 50 patients in each group.Among them,the control group only received methylprednisolone pulse therapy, and the observation group received dexamethasone and intrathecalinjection of methotrexate combined with methylprednisolone pulse therapy. The changes of cerebrospinalfluid, levels of cytokines, clinical response and mortality were compared between the twogroups. Results After the treatment, the cerebrospinal fluid pressure, protein and white blood cells ofthe two groups were significantly improved compared with those before the treatment (P <0.05). The totaleffective rate of the observation group was significantly higher than that of the control group (96.00%vs. 78.00%, P <0.05). After the treatment, the levels of cytokines such as tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), thymus activation regulating chemokine (TARC) and interferon inducibleprotein-10 (IP-10) in the two groups were significantly improved compared with those before treatment (P<0.05). After the treatment, there were no adverse reactions such as hypertension, gastrointestinalbleeding and infection in the observation group, while there were 1 case of upper gastrointestinal bleedingand 3 cases of pulmonary infection in the control group, and the incidence of adverse reactions was 8.00%.There was significant difference between the two groups (P <0.05). Within 12 months of follow-up, therecurrence rate in the observation group was significantly lower than that in the control group (22.00%vs. 34.00%, P <0.05). Conclusion Dexamethasone and intrathecal injection of methotrexate combinedwith methylprednisolone pulse therapy can effectively improve the cerebrospinal fluid environment, regulatethe level of local cytokines and relieve clinical symptoms in patients with systemic lupus erythematosusencephalopathy.