泼尼松联合甲氨蝶呤氯喹治疗系统性红斑狼疮的研究

Use of prednisone,methotrexate and chloroquine to treat systemic lupus erythromatosus

目的 回顾性研究 ,旨在探讨PMC治疗 (小剂量泼尼松合并甲氨蝶呤、氯喹 )对于轻、中度活动期SLE患者的疗效及副作用 ,以减少药物用量和副作用。方法 将入选的门诊患者按起始激素剂量 ,分为A (泼尼松剂量≤ 0 2mg·kg-1·d-1)和B (泼尼松 0 5～ 0 6mg·kg-1·d-1)两组 ,并联合应用甲氨蝶呤 7 5～ 10mg/周及氯喹 0 2 5g/d ,各 30例。观察疗效和副作用 ,为期 1年。结果 A组积分由治疗前的 2 1± 1 4降至 0 9± 0 7,B组感染多于A组 (2 2∶7,P <0 0 0 1) ,其中多为肺部感染 ,其次为皮肤感染。B组由 2 9± 2 3降至 1 3± 1 3。二组治疗前后相比疗效显著 ,但A、B两组间的疗效差异无显著性。B组中出现了库兴综合征及股骨头无菌性坏死 ,A组没有。结论 PMC方案对没有严重内脏累及的轻到中度的SLE患者有效。但在加大激素剂量的B组 。

Objective To research the therapeutic and adverse effects of PMC (small dosage prednisone combined with MTX and chloroquine) on systemic lupus erythromatosus (SLE) by a retrospective study.Methods The chosen out patients were enrolled into 2 groups (each n =30) by the dose of predinisone(group A,prednisone≤0 2 mg·kg -1 ·d -1 ;group B prednisone 0 5～0 6 mg·kg -1 ·d -1 ).All patients were administered MTX (7 5～10 mg/week) and chloroquine (0 25 g/d) at the same time.Then the therapeutic and adverse effects of the drugs were observed.The duration of follow up was one year.Results The OUT score of group A was reduced from 2 1±1 4 to 0 9±0 7,and group B from 2 9±2 3 to 1 3±1 3.The treatment was successful and there was no significant difference of efficacy between the two groups.However the infection rate occurred much higher in group B than group A ( P <0 001).Most infection occurred in lung,and then in skin .Cushing syndrome and aseptic necrosis of femoral head appeared in several patients in group B but none in group A.Conclusion It is shown that lupus patients with mild and moderate activity can be controlled well with PMC.And more prednisone means more infection.