环磷酰胺冲击治疗难治性成人斯蒂尔病初探  

Pulse cyclophosphamide therapy for refractory adult-onset Still's disease

作　　者：韩咏梅[1] 李永伟[1] 孙德本[1] 徐立勤[1] 朱红[2] 

机构地区：[1]浙江大学医学院附属第一医院风湿免疫科,杭州310003 [2]浙江省杭州市第三人民医院骨科,310009

出　　处：《中国实用内科杂志》2005年第12期1072-1074,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨环磷酰胺(CTX)冲击治疗对难治性成人斯蒂尔病(AOSD)的疗效及安全性。方法对浙江大学医学院附属第一医院风湿免疫科1998～2003年收治11例难治性AOSD患者进行CTX冲击治疗,用量为500～750mg/m2。观察治疗前后患者的临床表现和实验室指标的变化。结果11例难治性AOSD患者经首次CTX冲击治疗后,72h内体温恢复正常者9例,其余2例体温于1周内恢复正常;其中5例患者于首次CTX冲击治疗后第9天、第10天、第11天、第13天出现体温再次升高,经第2次CTX冲击治疗后体温恢复正常。与治疗前相比,首次CTX冲击治疗后1周,血C反应蛋白(CRP)即显著下降(P<0.001);首次CTX冲击治疗后2周、4周、3个月时血沉(ESR)、血CRP、血白细胞计数(WBC)均显著下降(P<0.001)。所有患者经治疗后,肾上腺糖皮质激素剂量均能顺利减至较安全范围内。治疗过程中,4例患者出现恶心、呕吐,未见其他严重不良反应。结论CTX冲击疗法对此11例难治性AOSD有效且未见严重不良反应。Objective To study the efficacy and safety of pulse cyclophosphamide （CTX） therapy for refractory adult - onset Still＇s disease （AOSD）, Methods Eleven patients with refractory AOSD received the treatment of intravenous pulse cyclophosphamide with 500 - 750 mg/m^2 body surface area. The features of clinical manifestations and lab findings before and after the treatment were compared. The literatures associated with pulse CTX therapy were reviewed. Results After the first time of pulse CTX therapy, nine cases returned body temperature to normal within 72 hours, and the other two within lweek. Fever relapse was seen in five patients after the first time of pulse CTX therapy, and they returned body temperature to persistent normal after the second time of pulse CTX therapy. At the point of 1 week after the first time of pulse CTX therapy, serum C - reactive protein （CRP） significantly decreased when compared with that before treatment （ P 〈0. 001 ） ; there were significant differences between those at the points of 2 weeks, 4 weeks, 3 months after the first time of CTX therapy and those before treatment in erythrocyte sedimentation rate （ESR） , serum CRP and white blood cell count （WBC） （ P 〈 0. 001 ）. Of all the eleven patients, the dosages of glucocorticoid were decreased to relatively safe dose successfully after treatment. The most common side effects seen in these eleven patients included nausea and vomiting （4/11 ） , but no other severe side effects occurred. Conclusion Pulse CTX therapy is effective in these eleven refractory AOSD patients. No severe adverse reaction occurred in these patients.

关 键 词：STILL病 成年型 环磷酰胺 冲击疗法 

分 类 号：R5[医药卫生—内科学]