硫唑嘌呤与羟氯喹联合糖皮质激素治疗轻中度系统性红斑狼疮的临床观察

目的探讨硫唑嘌呤(azathioprine,AZA)、羟氯喹(hydroxychloroquine,HCQ)联合糖皮质激素(简称ACP方案)治疗轻中度系统性红斑狼疮(systemic lupus erythematosus,SLE)的疗效。方法采用自身对照研究对甲氨蝶呤(methotrexate,MTX)、HCQ联合糖皮质激素(简称MCP方案)治疗6个月以上,因为没原因停用MTX、HCQ的37例轻中度SLE患者,换用ACP方案治疗6个月,观察其补体、血管炎样皮疹、尿蛋白等指标的变化。结果治疗前后dsDNA阳性率、血管炎表现、补体特别是补体C3及SLE活动性指数(SLE disease active index,SLEDAI)差异有统计学意义(P<0.05);狼疮肾炎患者尿蛋白明显降低(P<0.01)。结论病情活跃的轻中度SLE患者可以较早采用AZA、HCQ联合糖皮质激素治疗方案。

Azathioprine, hydroxychloroquine, and corticosteroid combination therapy successfully induces remission in patients with mild/moderate systemic lupus erythematosus

Objective To evaluate the efficacy and safety of azathioprine, hydroxychloroquine, and corticosteroid combination therapy for systemic lupus erythematosus（SLE） patients with baseline mild-to-moderate disease activity. Methods Thirty-seven SLE patients with baseline mild-to-moderate disease activity were enrolled in this self-controlled case-series study. Change of complement, vasculitis rash, urine protein and SLE disease active index （SLEDAI） were observed with the treatment of methotrexate and azathioprine in turn for more than six months combined with hydroxychloroquine and prednisone. Results Improvement of complement, vasculitis rash, urine protein, and SLEDAI was observed in the phase of azathioprine treatment compared with that in the phase of methotrexate treatment （p 〈 0.05 ）. Conclusions Azathioprine, hydroxychloroquine, and corticosteroid combination therapy is well tolerated and may prove to be an optimal alternative remission-inducing regimen for mild/moderate systemic lupus erythematosus..