甲氨蝶呤治疗系统性红斑狼疮的临床疗效及安全性分析

目的:观察甲氨喋呤(MTX)联合激素、羟氯喹治疗轻、中度活动性系统性红斑狼疮(SLE)患者的临床疗效及安全性。方法:选取60例SLE患者,随机分为试验组及对照组,各30例,对照组给予糖皮质激素0.5~1.0 mg/(kg·d)及羟氯喹治疗;试验组给予口服MTX片剂每周1次7.5~15 mg联合糖皮质激素和羟氯喹(用法同对照组),观察记录两组患者疗效、药物不良反应。结果:与治疗前比较,治疗后两组患者的SLE疾病活动指数(SLEDAI)评分均显著下降,差异有统计学意义(P﹤0.05),治疗后两组SLEDAI比较,差异具有统计学意义(P﹤0.05)。与治疗前相比,两组患者的补体C3、血沉得到了不同程度的改善,特别是在治疗3个月后试验组补体C3回升、血沉下降显著,差异有统计学意义(P﹤0.05)。治疗后激素累积剂量和日剂量比较差异有统计学意义(P﹤0.05)。对照组在激素减量过程中较难减量,更易复发,对照组出现不良反应较多,两组间比较差异有统计学意义(P﹤0.05)。结论:MTX治疗SLE有效,加用MTX可减少激素用量,起到"激素助减剂"的作用,防止长期使用偏大量激素引起相关不良反应,为SLE患者治疗提供一个有效、安全的治疗方案。

Efficacy and safety of methotrexate treatment of systemic lupus erythematosus

Objective To evaluate the efficacy and safety of methotrexate （MTX） in combination with glucoeortieolds （CC） and hydroxychloroquine（HCQ） in patients with mild- to- moderate systemic lupus erythematosus （SLE）. Method Sixty patients with SLE were assigned to two groups randomly. Patients in control group received GC（0.5 - 1.0 mg/kg d） and HCQ ,while padcnts in treatment group received MTX 7.5 - 15 rag/week orally in addition to GC and HCQ. Treatment response and adverse effects were recorded. Results SLEDAI scores were significantly decreased in both groups after the treatment than before（P 〈 0. 05）. SLEDAI scores were smaller in treatment group than control group（P 〈 0. 05）. In treatment group,the serum level of C3 was significantly increased and ESR was decreased three months after the treatment（P 〈 0. 05）. Both the accumulated dose and daily dose of GC were less in treatment group than in control group（ P 〈 0.05）. More patients were GC -- dependent and more patients relapsed in control group（ P 〈 0. 05）. The incidence of adverse effects was higher in control group（ P 〈 0. 05 ）. Conclusion MTX is effective in SLE and can reduce the dose of GC so as to reduce GC -related adverse effects.