不同剂量甲基强的松龙联合环磷酰胺治疗狼疮脑病对比研究

Comparative study of different doses of methylprednisolone combined with cyclophosphamide in the treatment of lupus encephalopathy

目的探讨不同剂量甲基强的松龙联合环磷酰胺治疗狼疮脑病(NPSLE)的临床疗效及对患者神经功能及血清炎性因子水平的影响。方法以焦作市第二人民医院2017-02—2019-02治疗的60例狼疮脑病患者为研究对象,按照随机数字法分为低剂量组、中剂量组、高剂量组,每组20例。低剂量组患者接受低剂量甲基强的松龙联合环磷酰胺治疗,中剂量组接受中剂量甲基强的松龙联合环磷酰胺治疗,高剂量组接受高剂量甲基强的松龙联合环磷酰胺治疗,分析3组患者临床疗效、神经功能及血清炎性因子水平的变化。结果治疗前3组间SLEDAI评分差异无统计学意义(P>0.05);治疗15 d、30 d时高剂量组SLEDAI评分显著低于低剂量组、中剂量组,组间比较差异有统计学意义(P<0.05);治疗30 d后中剂量组、高剂量组精神症状改善效果显著优于低剂量组(P<0.05),且中剂量组、高剂量组患者精神症状改善效果无显著差异(P>0.05);治疗30 d后3组患者血清炎性因子IL-1β、IL-6、IL-8、IFN-α水平与治疗前相比均显著改善(P<0.05),但中剂量组、高剂量组患者血清各炎性因子水平显著优于低剂量组(P<0.05),且中剂量组、高剂量组患者血清炎性因子改善效果差异无统计学意义(P>0.05)。结论中剂量甲基强的松龙联合环磷酰胺治疗NPSLE对提高患者临床疗效、改善神经功能及血清炎性因子水平效果显著。

Objective To investigate the effects of different doses of methylprednisolone combined with cyclophosphamide on the neurological function and serum inflammatory factor levels of lupus encephalopathy(NPSLE).Methods Based on 60 cases of lupus encephalopathy received by the Inpatient Department of Jiaozuo Second People’s Hospital from February 2017 to February 2019,they were divided into three groups according to random group fraction method:low dose group,medium dose group and high dose group,with 20 patients in each group.The patients in the low dose group received low dose methylprednisolone combined with cyclophosphamide,the middle dose group received medium dose methylprednisolone combined with cyclophosphamide,and the high dose group received methylprednisolone combined with cyclophosphamide.The changes of clinical efficacy,nerve function and serum inflammatory factor level in the three groups were statistically analyzed.Results Before treatment,the difference in SLEDAI score between the three groups was not statistically significant(P>0.05);the SLEDAI score of the high-dose group was significantly lower than that of the low-dose group and the middle-dose group at 15 and 30 days of treatment,and the difference between the groups was statistically significant(P<0.05);after 30 days of intervention treatment,the effect of improving the mental symptoms of the middle-dose group and the high-dose group was significantly better than that of the low-dose group(P<0.05),and there was no significant difference in the improvement of the mental symptoms of the middle-dose group and the high-dose group(P>0.05);after 30 days of treatment,the serum inflammatory factors IL-1β,IL-6,IL-8,and IFN-αin the three groups were significantly improved compared with before treatment(P<0.05),but the middle-dose group and high-dose The improvement level of serum inflammatory factors in the patients in the group was significantly better than that in the low-dose group(P<0.05),and there was no significant difference in serum inflammatory factors in the middle-dose and high-dose groups(P>0.05).Conclusion The treatment of NPSLE with medium-dose methylprednisolone combined with cyclophosphamide is effective in improving the clinical therapeutic effect and improving the neurological function and serum inflammatory factor levels in patients.It is worthy of clinical application.