大剂量环磷酰胺治疗难治性类风湿关节炎初探

High-dose cyclophosphamide chemotherapy for refractory rheumatoid arthritis

目的 研究大剂量化疗 (high dosechemotherapy ,HDC)治疗难治性类风湿关节炎(RA)的可行性、有效性及安全性。方法 对 4例常规治疗效果不佳的难治性RA患者进行大剂量环磷酰胺 (CTX)治疗 ,用量为 80～ 10 0mg/kg ,总量 4～ 5 g分 2～ 3d给药。观察此 4例患者治疗前后的临床转归和实验室改变 ,并进行相关文献复习。结果 4例难治性RA患者经HDC后 ,2例随访 12个月 ,2例随访 6个月 ,RA活动指数均明显下降 ,达ACR5 0标准病情缓解 ;且 4例患者均对大剂量CTX耐受性良好 ,无严重不良反应发生。结论 HDC对此 4例难治性RA的治疗安全、可行 ,且临床症状完全缓解。但如何选择合适的病例尚待进一步探讨 。

Objective To study the feasibility,efficacy,and safety of high dose cyclophosphamide (HDC) chemotherapy for refractory rheumatoid arthritis (RA).Method Four patients with refractory RA received the treatment of HDC.Cyclophosphamide was chosen for high dose chemotherapy with 80～100 mg/kg within 2 or 3 days,total dosage was 4 or 5 g.The features of clinical manifestation and lab findings before and after the treatment were compared.The literatures associated with HDC were reviewed.Results All of four patients achieved complete remission and remained in continuous complete remission for 6 to 12 months of follow up.The lab findings associated with disease activity were nearly normal.HDC was well tolerated and there were no severe side effects.Conclusion HDC chemotherapy is feasible and safe in these four refractory RA patients,it induced complete remission in them.But it is very important to select refractory RA patients,and it need more patients and longer follow up period to know if HDC.