尼美舒利与甲氨蝶呤联合治疗成人斯蒂尔病

Treatment of adult-onset Still's disease with nimesulide-methotrexate combined therapy

目的探讨尼美舒利与甲氨蝶呤(MTX)联合治疗成人斯蒂尔病的疗效.方法成人斯蒂尔病23例,接受尼美舒利与甲氨蝶呤联合治疗方案:口服尼美舒利100 mg,每12 h 1次;生理盐水40 ml+MTX10mg,静脉注射,每周1次,4次后改为口服MTX 10 mg,每周1次.联合治疗3 d,体温仍不下降者,加用泼尼松,每日10 mg;治疗7 d不降者,泼尼松改为每日30 mg.运用生存分析的方法观察控制发热的时间和复发的时间;同时观察治疗前后血白细胞、血沉、C反应蛋白、血清铁蛋白4项实验室指标以及副反应.结果 19例(82%)在用药后24h内体温恢复正常,2例在加用泼尼松10 mg/d后控制发热,1例需要将泼尼松剂量增加到30 mg/d.另有1例增加激素剂量无效,需加用环孢素A才能控制病情.3例病人在减药的过程中复发,另有1例在停药后复发.16例已经完全停药,疗程6～14个月,中位数11个月,5例只用MTX维持,疗程8～16个月,1例需要泼尼松30mg/d和另1例需要环孢素A治疗者,目前仍需MTX和泼尼松10 mg/d维持.治疗后3个月15例(65%)和治疗后6个月19例(83%)4项实验室指标均恢复正常.全部病人在治疗初期均出现多汗现象,多汗持续5～36 d,中位数8 d,其中2例出现低血压需要临时静脉补液.2例出现轻度的丙氨酸转氨酶升高.结论尼美舒利与MTX联合治疗成人斯蒂尔病具有良好疗效.

Objective To explore the effect of a combined therapy of nimesulide and methotrexate in adult-onset Still′s disease (AOSD).Methods Twenty-three patients of AOSD received nimesulide-methotrexate combined therapy:nimesulide 10 mg twice daily and methotrexate 10 mg weekly.Prednisone 10 mg/d was given when fever was not controlled within 3 days, and its dose would be increased to 30 mg if it was still not effective in 7 days.The time of fever control and relapse was analyzed by survival analysis.Laboratory parameter such as WBC,ESR,CRP,serum ferritin and side effects were observed before and after treatment.Results Nineteen cases (82%) normalized their body temperature within 24 hours.Prednisone treatment was needed in 3 cases (10 mg per day in two cases,30 mg per day in one case),and cyclosporine was given to one case in addition.Three cases relapsed during decrease of drugs,while one case relapsed after cease of treatment.Treatment of 16 cases had been finished,the courses of which were 6 to 14 months (mean course 11 months).Two cases were still treated with methotrexate and prednisone 10 mg per day now,and five cases maintained well with methotrexate only.Laboratory parameter recovered in 3 months after treatment in 15 cases (65%) and 6 months in 19 cases (82%).Side effects included hyperhidrosis in all cases in the beginning of treatment,hypotension in 2 cases and aminotransferase increase in 2 cases.Conclusion The combination of nimesulide and methotrexate is an effective therapy in AOSD.