静脉滴注免疫球蛋白联合糖皮质激素治疗老年人皮肌炎的临床观察

目的 探索静脉滴注免疫球蛋白联合糖皮质激素治疗老年人皮肌炎的疗效及其安全性. 方法 60例老年皮肌炎患者随机分为两组,30例单用口服激素治疗组(单用组),泼尼松初始剂量为每天1 mg/kg;另外30例在接受口服激素治疗(泼尼松初始剂量为每天1 mg/kg)基础上给予静脉滴注免疫球蛋白治疗(联用组)每天0.4 g/kg,每月连续3 d,共3个月.观察治疗3个月末两组临床症状改善情况及药物不良反应. 结果 联用组自觉肌力开始恢复的时间为(19.5±7.3)d,明显早于单用组的(25.3±8.7)d(P<0.01);联用组肌无力改善程度为(71.0±23.0)%,高于单用组(56.0±19.0)%;两组肌肉疼痛改善视觉模拟疼痛(VAS)评分(3.5±1.7比2.6±1.3)、磷酸肌酸激酶(CPK)下降率[(80.4±26.3)%比(60.5±21.7)%]及治疗3个月末激素用量[(26.3±12.7)mg/d比(35.7±15.5)mg/d3比较,差异均有统计学意义(P<0.05),而两组皮疹、肌力改善、血沉、C反应蛋白比较,差异无统计学意义(均为P>0.05).两组不良反应发生率差异无统计学意义(P>0.05).结论联用免疫球蛋白治疗老年人皮肌炎,可迅速缓解症状,显著降低磷酸肌酸激酶,减少激素用量,且不良反应少,耐受性好.

Efficacy and safety of the combined treatment with intravenous immunoglobulin and oral glucocorticoid in the elderly with dermatomyositis

Objective To explore the efficacy and safety of intravenous immunoglobulin and glucocorticoid treatment in elderly dermatomyositis patients. Methods Sixty elderly patients with dermatomyositis were randomly divided into two groups: prednisone alone (n= 30, PA) (first 1 mg per kilogram of body weight daily,then decrease the dose according to disease activity), and the combined treatment (n=30,CT,first 1 mg per kilogram of body weight daily, then decrease the dose according to disease activity, and intravenous immunoglobulin 0. 4 g per kilogram of body weight per month for three months). The improvement of clinical symptoms and the occurrence of side effects were observed at the end of month 3. Results The time of muscle strength recovery, remittences of myasthenia and myalgia visual analogue scale(VAS), the decreasing rates of creatine phospho kinase (CPK) level and the dose of prednisone at the end of month 3 were superior in CT group versus PA group (P<0. 05), while no significant differences in the improvement of rash, muscle strength,erythrocyte sedimentation rate(ESR),C-reactive protein (CRP) and side effects between two groups.Conclusions Combination with intravenous immunoglobulin and oral glucocorticoid is a safe and effective treatment for elderly patients with dermatomyositis, it can alleviate symptoms quickly,decrease CPK level and prednisone dose significantly.