环磷酰胺联合小剂量沙利度胺对HLA-B51阴性/阳性白塞病患者血液流变学的影响

Effect of cyclophosphamide combined with low-dose thalidomide on hemorheology in patients with HLA-B51 negative/positive Behcet’s disease

目的探讨环磷酰胺联合小剂量沙利度胺对人类白细胞抗原-B51(HLA-B51)阴性/阳性白塞病的疗效及对患者血液流变学指标的影响。方法回顾性分析2018年5月—2020年3月于中国科学技术大学附属第一医院(安徽省立医院)治疗的120例白塞病患者的临床资料,根据治疗方式将患者分为对照组和试验组,每组各60例。对照组患者给予沙利度胺片口服治疗,50 mg/次,1次/d,晚上服用。试验组患者在对照组治疗基础上联合环磷酰胺片口服治疗,起始剂量为200 mg/次,1次/d,根据患者病情减量,减至50 mg/次,1次/d,维持治疗。两组患者均进行1年的治疗。比较两组患者治疗前后血液流变学指标及炎症因子水平变化,观察两组患者临床疗效及主症有效率变化,以及不良反应发生情况。结果经过1年的药物治疗,试验组患者的治疗总有效率为90.00%,明显高于对照组的73.33%,差异具有统计学意义(P<0.05)。治疗后试验组患者关节炎、眼炎、口腔溃疡等主要症状有效率均明显高于对照组(P<0.001)。与治疗前相比,治疗后两组患者血清白细胞介素-8(IL-8)、IL-6、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)水平均显著降低(P<0.001),血液流变学指标红细胞聚集指数(AI)、血浆黏度(ηP)、全血低切黏度(ηbL)、全血高切黏度(?bH)均明显降低(P<0.001),且试验组上述指标改善效果较对照组显著(P<0.001)。两组患者不良反应发生率无明显差异(P>0.05)。结论环磷酰胺联合小剂量沙利度胺治疗白塞病,可以明显改善患者临床症状及血液流变学指标,减轻机体炎症反应,疗效显著。

Objective To investigate the effect of cyclophosphamide combined with low-dose thalidomide on human leukocyte antigen-B51(HLA-B51) negative/positive Behcet’s disease and its effect on hemorheological indexes. Methods The clinical data of120 patients with Behcet’s disease treated in the First Affiliated Hospital of China University of Science and Technology(Anhui Provincial Hospital) from May 2018 to March 2020 were analyzed retrospectively. According to the treatment method, the patients were divided into control group and experimental group, with 60 cases in each group. Patients in the control group were given Thalidomide Tablets orally, 50 mg/time, once a day, in the evening. On the basis of the treatment of the control group, the patients in the experimental group were treated with Cyclophosphamide Tablets orally. The initial dose was 200 mg/time, once a day. According to the patient’s condition, it was reduced to 50 mg/time, once a day for maintenance treatment. Both groups were treated for one year.The changes of hemorheological indexes and inflammatory factors before and after treatment were compared between two groups,and the changes of clinical efficacy, effective rate of main symptoms, and incidence of adverse reactions were observed. Results After one year of drug treatment, the total effective rate of the experimental group was 90.00%, which was significantly higher than73.33% of the control group(P < 0.05). After treatment, the effective rates of arthritis, ophthalmia and oral ulcer in the experimental group were significantly higher than those in the control group(P < 0.001). Compared with before treatment, serum interleukin-8(IL-8), IL-6 and tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP) in two groups after treatment were significantly decreased(P < 0.001), hemorheological indexes, such as erythrocyte aggregation index(AI), plasma viscosity(ηP), low shear viscosity of whole blood(?BL), and whole blood high shear viscosity(ηBH) were significantly decreased(P < 0.001), and the improvement effect of the above indexes in the experimental group was significantly higher than that in the control group(P <0.001). There was no significant difference in the incidence of adverse reactions between the two groups(P > 0.05). Conclusion Cyclophosphamide combined with low-dose thalidomide in the treatment of Behcet’s disease can significantly improve the clinical symptoms and hemorheological indexes, reduce the inflammatory reaction of the body, and has a significant effect.