甲氨蝶呤联合环孢素A治疗难治性狼疮肾炎的临床疗效  

Clinical observation of methotrexate combined with cyclosporine A in the treatment of refractory lupus nephritis

作　　者：张科[1] 邱茜[2] 廖兢业[1] 梁柳琴[2] 何春媚[1] 

机构地区：[1]广东省梅州市人民医院风湿科,514000 [2]中山大学附属第一医院风湿免疫科,广州市510080

出　　处：《实用医学杂志》2013年第13期2192-2194,共3页The Journal of Practical Medicine

基　　金：广东省梅州市科技计划项目(编号:2011B07)

摘　　要：目的:探讨甲氨蝶呤联合环孢素A治疗难治性狼疮肾炎的临床效果。方法:收集2010年9月至2012年12月在梅州市人民医院风湿科门诊或住院的21例难治性狼疮肾炎患者。给予甲氨蝶呤每周10～15mg联合环孢素A3～5mg/(kg·d),分2次服用,泼尼松≤1mg/(kg·d),观察期为6个月。结果:患者治疗前后的系统性红斑狼疮活动指数、24h尿蛋白定量、血清白蛋白、补体C3和抗ds-DNA抗体滴度差异均有统计学意义(P<0.05)。在治疗1个月内,34%的患者起效,第3个月末时,有效率达71%,在研究6个月时,6例患者获完全缓解,11例患者达部分缓解,有效率达81%。本组患者不良反应少,且经对症处理后症状可逐渐减轻消失。2例甲氨蝶呤及环孢素A减量过快的患者出现了病情波动。结论:应用甲氨蝶呤联合环孢素A治疗难治性狼疮肾炎快速且有效,不良反应小。甲氨蝶呤及环孢素A减量过快时,可出现狼疮肾炎的病情复发。Objective To observe the efficacy and side effects of methotrexate combine cyclosporine A in the treatment of refractory lupus nephritis （RLN）. Methods 21 RLN patients were treated with methotrexate 10 to 15mg weekly, and cyclosporine A 3 to 5 mg/（kg.d）, in two equally divided doses, prednisone ≤ 1 mg/（kg.d）. The systemic lupus erythematosus activity index （SLEDAI score）, urinary protein in 24 hours, serum albumin, complement C3 and anti-ds-DNA antibody titers were compared, the efficacy and side effects were observed. Results The SLEDAI score, urinary protein and anti-ds-DNA antibody titers decreased, while serum albumin and complement C3 increased, and all the differences were statistically significant （P 〈 0.05）. The response rate （effective rate） was 34% in the 1st month, 71% in the 3rd and 81% in the 6th. Adverse reactions were rare, and could gradually disappear after management. The illness states of 2 patients undulated because of too fast doses subtraction of methotrexate and cyclosporine A. Conclusions Methotrexate combine cyclosporine A had efficacy for the treatment in RLN, Reduction of methotrexate and cyclosporine A too quick may cause recurrence.

关 键 词：红斑狼疮 系统性 狼疮肾炎 甲氨蝶呤 环孢素A 

分 类 号：R593.241[医药卫生—内科学]