以泼尼松为主联合治疗多发性肌炎和皮肌炎32例

Combined Treatment of 32 Cases of Polymyositis and Dermatomyositis with Prednisone as the Basic Remedy

目的 :比较泼尼松联合疗法和单用治疗多发性肌炎 (PM)和皮肌炎 (DM)的疗效。方法 :PM和DM患者67例分为对照组 (单用糖皮质激素 ) 3 5例 ,给予泼尼松 1mg·kg 1 ·d 1 ,qd。治疗组 3 2例 ,给予泼尼松 1mg·kg 1 ·d 1 ,qd ,加甲氨蝶呤片 7.5～ 10 .0mg ,po,每周 1次 ;加火把花根片 3片 ,tid。疗程 4周。主要观察指标有肌力变化 ,皮疹 ,血清ALT、AST、LDH、CK的水平及药物副作用发生率。结果∶治疗后两组患者的肌力均有不同程度改善 ,肌力改善幅度≥ 2级患者在对照组中占 5 4.3 % ,在治疗组中占 62 .5 % ,二者差异无显著性 (P >0 .0 5 )。两组患者在治疗后血清ALT、AST、LDH、CK水平均比治疗前有明显下降 ,差异有极显著性 (P <0 .0 1)。治疗组患者的血清ALT、AST、LDH、CK下降的幅度明显大于对照组 ,差异有显著性 (P <0 .0 5 )。结论 :与单用糖皮质激素的疗法相比 ,联合治疗方法能够使血清肌酶更快地下降 ,对PM和DM有更好的近期疗效。

Objective:To compare the therapeutic effectiveness of prednisone combined with other drugs with that of prednisone alone in the treatment of polymyositis (PM) and dermatomyositis (DM). Methods:67 patients with PM and DM were divided into 2 groups. Patients of the control group ( n =35) were given each 1 mg·kg 1 of prednisoone alone, PO, q.d.. On the basis of the same prednisone therapy as that in the control group,patients of the treatment group ( n =32) were given each additionally 7.5～10.0 mg of methotrexate, PO, per week, 3 tablets of colquhounia root ( traditional Chinese medicine), PO, t.i.d.. The course of treatment in both groups tasted 4 weeks. Myodynamia, skin rash,serum levels of ALT, AST, LDH and creatinine kinase (CK), as well as drug adverse reactions were kept under observation. Results:After the treatment, myodynamia in patients of both groups showed different degrees of improvement. 54.3% of the patients in the control group and 62.5% of those in the treatment group had a ≥2 grade improvement of myodynamia. The difference between the 2 groups was insignificant ( P >0.05). Serum levels of ALT, AST, LDH and CK levels were strikingly lowered in patients of both groups as compared with those before the treatment ( P <0.01). However, the extent of the lowering of ALT, AST, LDH and CK levels was evidently greater in patients of the treatment group than in those of the control group ( P <0.05). Conclusion:Combined treatment was shown to result in a more rapid decline of serum muscle enzyme levels and to exert a better short term therapeutic effect in the treatment of PM/DM, as compared with treatment with prednisone alone.