鞘内注射甲氨蝶呤与地塞米松联合口服激素治疗神经精神性狼疮的系统评价

目的：评价鞘内注射甲氨蝶呤（methotrexate，MTX）与地塞米松（dexamethasone，DXM）联合口服激素在神经精神性狼疮（neuropsychiatric systemic lupus erythematosus，NPSLE）治疗中的效果。方法：全面检索1996年1月—2016年12月关于鞘内注射MTX与DXM治疗NPSLE的临床试验文献，采用激素或激素联合环磷酰胺治疗作为对照组，鞘内注射MTX与DXM联合口服激素治疗作为治疗组的随机对照试验进行meta分析。结果：纳入6项研究，256例NPSLE，对照组和试验组的例数分别为126例和130例。meta分析结果显示，治疗组在降低系统性红斑狼疮疾病活动度评分（systemic lupus erythematosus disease activity index，SLEDAI）方面均优于对照组（P<0.01）；并且脑脊液压力、脑脊液蛋白、血沉等相关指标，治疗组均低于对照组（P<0.01）。结论：鞘内注射MTX与DXM联合口服激素的效果优于单纯口服激素；但是由于文献的方法学质量较低，仍需要高质量、大样本、多中心的随机临床试验加以验证。

System review of intrathecal injection of methotrexate and dexamethasone in treatment of neuropsychiatric systemic lupus erythematosus

Objective: To evaluate the effectiveness of intrathecal injection of methotrexate (MTX) and dexamethasone (DXM) combined with glucocorticoid in treatment for neuropsychiatric systemic lupus erythematosus(NPSLE). Methods: The clinical literatures about intrathecal injection of MTX and DXM combined with glucocorticoid in treatment of NPSLE were collected from January 1996 to December 2016. Meta-analysis was performed by comparing control with treatment group. The control group was treated with glucocorticoid or glucocorticoid combined with cyclophosphamide. The treatment group was treated with intrathecal injection of MTX and DXM combined with glucocorticoid. Results: A total of 6 clinical trials with 256 NPSLE patients were included. There were 126 patients in the control group and 130 patients in the treatment group. Meta-analysis indicated that the treatment group was superior to control group in cerebrospinal fluid pressure, cerebrospinal fluid protein, erythrocyte sedimentation rate, and systemic lupus erythematosus disease activity index (SLEDAI) (all P<0.01). Conclusion: The curative effect of treatment group is superior to that of the control group. However, due to the low methodological quality of the literature, it still needs large sample, multi-center, high-quality clinical research trails.