鞘内注射治疗狼疮中枢受累的临床观察

Clinical Observation of Intrathecal Injection in the Treatment of Systemic Lupus Erythematosus

目的 :探讨鞘内注射甲胺蝶呤 (MTX)和地塞米松 (DXM)对治疗狼疮中枢受累 (CNS- SL E)的疗效。方法 :选择 2 2例狼疮中枢受累患者根据治疗方法不同分为对照组和观察组 ,对照组为甲泼尼龙 (MP)和环磷酰胺 (CTX)冲击治疗的病人 ,观察组为在联合冲击治疗基础上加用鞘内注射治疗的病人 ,观察各组临床症状缓解情况、血清学指标变化及不良反应。结果 :对照组和观察组两组在补体恢复、SL EDAI活动积分下降、脑脊液蛋白下降、精神神经症状改善等方面差异均有统计学意义 ,冲击加鞘注疗法优于单纯冲击治疗。两组外周血白细胞减少、感染、肝功能异常、化学性脑膜炎等副作用方面无差异。结论 :对于 CNS- SL

Objective: To study the effect of intrathecal injection of methotrexate (MTX) and dexamethasone (DXM) on the treatment of CNS-SLE.Methods: 22 patients with CNS-SLE were divided into the control group and the experiment group according to different treatment methods. The control group were treated with cyclophosphamide (CTX) and methylprednisolone (MP), while the experiment group were treated with intrathecal injection of MTX and DXM in addition to CTX and MP treatment. The alleviation of clinical symptoms, alteration of serological indexes and occurrence of side effects were closely observed.Results: The experiment group is doing better as reflected through the stronger complement recovery, remission of psychoneurosis symptoms, decrease of SLEDAI scores, and lowering of cerebrospinal protein level, suggesting that intrathecal therapy is more effective. There exist no significant differences between the two groups in examining side effects such as decrease of periphery white blood cell number, infection, abnormal liver function, and chemical meningitis.Conclusion: Intrathecal injection is a kind of therapy effective towards the treatment of severe CNS-SLE.