鞘内注射甲氨喋呤、地塞米松治疗神经精神狼疮的近期疗效观察

目的探索安全有效的治疗神经精神狼疮（NPSLE）方法。方法36例NPSLE随机分成两组，两组均甲泼尼龙（MP）静脉冲击1g3d，实验组联合鞘内注射甲氨蝶呤（MTX）10mg和地塞米松（DXM）10mg，每周1次，≤3次。对照组每周应用环磷酰胺（CTX）0．4g 1次，≤3次。观察两组平均住院日、治疗前后系统性红斑狼疮活动指数（SLE-DAI）和脑脊液参数、院内感染和白细胞减少及其他不良反应。结果实验组平均住院日显著短于对照组（P=0．024）；两组均能有效降低SLEDAI，实验组显著优于对照组（P=0．023）。两组均能有效降低脑脊液压力、脑脊液蛋白、脑脊液细胞数，实验组也显著优于对照组（P=0．013、0．043、0．004）。实验组发生院内感染、白细胞减少例数均显著低于对照组（P=0．027、0．019）。结论MP静脉冲击联合鞘内注射MTX和DXM治疗NPSLE疗效显著且安全，

The Recent Effects of Pulse Therapy of Methylprednisolone Combinded with Intrathecal Methotrexate and Dexamethasone on Patients with Neuropsychiatric Systemic Lupus Erythematosus

Objective To search for an effective and safe treatment for neuropsych-iatric systemic lupus erythematosus(NPSLE). Methods 36 patients with NPSLE were rand-omly divided into two groups, two groups were treated with pulse therapy of methylp-rednisolone(MP) 1g for 3 days,one combinded with intrathecal (IT)methotrexate(MTX)10 mg and dexamethasone(DXM) 10 mg once a week,another combinded with intravenous cyclophosphamide(CTX) 0.4g per week,two ways were no more than 3 times.The mean duration of hospitalizetion,mean SLEDAI score, parameter of cerebrospinal fluid(CSF) and incident of nosocomial infection and leucopenia of both groups were compared.Results The mean duration of hospitalizetion,mean SLEDAI score and the parameter of CSF such as pressure,protein and leucocyte of IT-group were significantly lower than that of no-IT group (P=0.024, 0.023,0.013,0.043 and 0.040 respectively).The incidence of nosocomial infection and leucopenia of IT group were also significantly less than that of no-IT group(P=0.027 and 0.019 respectively).Conclusions Pulse therapy of MP combinded with IT MTX and DXM was a safe and effective treatment for NPSLE.