激素联合丙种球蛋白治疗难治性成人斯蒂尔病的临床观察

Clinical observation of glucocorticoid combined with gamma globulin in treatment of refractory adult onset Still's disease

目的 探讨难治性成人斯蒂尔病(AOSD)病人采用激素联合丙种球蛋白治疗临床效果和安全性。方法 选择淮南市第一人民医院风湿免疫科2019年1月至2021年8月收治的难治性AOSD病人30例为研究对象,均采用甲泼尼龙2 mg·kg^(-1)·d^(-1)联合丙种球蛋白400 mg·kg^(-1)·d^(-1)×5 d治疗,对激素联合丙种球蛋白治疗的临床治疗效果采用的临床表现、实验室指标进行观察。结果 在治疗的30例AOSD病人时,4例在治疗的第1天后体温恢复正常,6例在治疗的第2天体温恢复正常,14例在治疗的第3天体温恢复正常,4例在治疗的第4天体温恢复正常,治疗5天后所有病人体温恢复正常,皮疹消退,关节肿痛缓解,咽痛好转,淋巴结及脾脏肿大较治疗前明显减小。与治疗前对比,治疗2月后病人临床表现消失,6月后病情维持缓解,血沉[(108±26)mm/h比(21±8)mm/h、(12±3)mm/h,F=181.03,P<0.05]、C反应蛋白(CRP)[(136±46)mg/L比(7.0±2.4)mg/L、(3.0±1.2)mg/L,F=180.86,P<0.05]、铁蛋白[(3 230±1 420)μg/L比(320±156)μg/L、(160±46)μg/L,F=91.46,P<0.05]、白细胞[(18.2±4.9)×10^(9)/L比(8.2±1.7)×10^(9)/L、(5.9±1.2)×10^(9)/L,F=81.92,P<0.05]明显改善,第2周、1月、2月、3月、6月实验室检查持续改善。治疗期间均无不良反应发生。结论 丙种球蛋白能迅速改善难治性成人斯蒂尔病病人的临床症状及实验室指标,且有显著的临床治疗效果,复发率低,并有利于激素的减量,减量后病情仍维持稳定状态,同时有利于避免大剂量激素治疗后发生感染风险。

Objective To explore the clinical effect and safety of glucocorticoid combined with gamma globulin in the treatment of refractory adult-onset still's disease(AOSD).Methods Thirty patients with refractory AOSD admitted to the Department of Rheumatology and Immunology of Huainan First People's Hospital from January 2019 to August 2021 were studied.All were treated with methylprednisolone 2 mg·kg^(−1)·d^(−1) combined with gamma globulin 400 mg·kg^(−1)·d^(−1)×5 d.The clinical therapeutic effect was observed by clinical manifestations and laboratory indexes.Results Among the 30 refractory AODS patients treated,the body temperature of 4 cases returned to normal after the first day of treatment,the body temperature of 6 cases returned to normal after the second day of treatment,the body temperature of 14 cases returned to normal after the third day of treatment,the body temperature of 4 cases returned to normal after the fourth day of treatment,after 5 days of treatment,the body temperature of all patients returned to normal,the rash subsided,and the swelling and pain of the patients were relieved,and the sore throat was improved,and the enlargement of lymph nodes and spleen was significantly reduced.Compared with before treatment,the clinical manifestation disappeared after 2 months of treatment,the condition remained in remission after 6 months.ESR[(108±26)mm/h vs.(21±8)mm/h,(12±3)mm/h,F=181.03,P<0.05],CRP[(136±46)mg/L vs.(7.0±2.4)mg/L,(3.0±1.2)mg/L,F=180.86,P<0.05],SF[(3230±1420)μg/L vs.(320±156)μg/L,(160±46)μg/L,F=91.46,P<0.05],WBC[(18.2±4.9)×10^(9)/L vs.(8.2±1.7)×10^(9)/L,(5.9±1.2)×10^(9)/L,F=81.92,P<0.05]were improved significantly.The laboratory tests continued to improve at the 2nd week,the 1st month,the 2nd month,the 3rd month and the 6th month.No adverse reactions occurred during treatment.Conclusion Gamma globulin can rapidly improve the clinical symptoms and laboratory indexes of refractory adult-onset still's disease,and it has significant clinical therapeutic effect,low recurrence rate,and is beneficial to glucocorticoid reduction,the disease remains stable after reduction,and is beneficial to avoid the risk of infection after high-dose glucocorticoid therapy.