糖皮质激素治疗嗜酸细胞肉芽肿性多血管炎的近期与远期疗效分析  

Analysis the short and long-term effectiveness of glucocorticoid in the treatment of eosinophilic granulomatosis with polyangiitis

作　　者：高懿卓[1] 郭晓雪[1] 范晶晶[1] 叶蕊[1] 赵立[1] 

机构地区：[1]中国医科大学附属盛京医院第一呼吸内科,沈阳110004

出　　处：《中国临床药理学杂志》2017年第10期888-892,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的观察嗜酸细胞肉芽肿性多血管炎(EGPA)患者经糖皮质激素和/或联合免疫抑制剂治疗的近期与远期疗效。方法收集自2008年1月至2016年2月我院收治的确诊嗜酸细胞肉芽肿性多血管炎的36例病例的资料,所有患者给予药物治疗,包括但不仅限于糖皮质激素,其余包括免疫抑制剂如环磷酰胺、硫唑嘌呤等;糖皮质激素剂量及疗程依据病情及治疗反应确定,糖皮质激素包括静脉及口服剂型,免疫抑制剂为静脉剂型。观察所有患者急性期治疗前后临床症状与实验室检查的前后对比评价近期疗效。2016年9月,对所有患者进行门诊及电话随访,评价远期疗效。结果初始治疗为单药糖皮质激素的32例患者纳入近期疗效评价,所有患者的临床症状均有不同程度的好转,治疗前后嗜酸细胞计数分别为(1.48±0.81)×109/L,(0.22±0.36)×109/L,嗜酸细胞百分比分别为(17.35±8.50)%,(2.95±4.90)%,总免疫球蛋白E分别为(750.95±1040.11),(343.87±489.53)U·m L^(-1),C反应蛋白(CRP)分别为(44.44±37.65),(17.80±13.29)mg·L^(-1),红细胞沉降率(ESR)分别为(58.25±40.61),(23.55±10.34)mm·h-1,差异均有统计学意义(P<0.05)。长期随访结果提示,患者五因素评分(FFS)越高,复发风险越高,远期疗效越差。结论糖皮质激素对于EGPA急性期症状控制效果显著;对于存在重要器官受累的患者糖皮质激素的长期疗效差,复发风险高,应尽早给予免疫抑制剂等的联合治疗以减少疾病的复发。Objective To investigate the short- term and long- term clinical effect of eosinophilic granulomatosis with polyangiitis （EGPA） patients treated with corticosteroids and/or immunosuppressants. Methods A total of 36 cases who fuffilled the eosinophilic granulomatosis with polyangiitis diagnosis from January 2008 to February 2016 were collected including their information and the acute clinical symptoms as well as laboratory findings before and after treatment to evaluate short -term effect. We also evaluated the long -term effect by outpatient or telephone at September 2016. All patients were treated with drugs, including but not limited to corticosteroids, others consisting of immunosuppressants such as cyclophosphamide, azathioprine ; glucocorticoid dosage based on the severity and effects, corticosteroids including intravenous and oral form, immunosuppressants for intravenous form. Results We assessed short - term effectiveness by 32 patients with initial pure glucocorticoid treatment, clinical symptoms were improved. The eosinophils before and after treatment were （1.48 ±0. 81 ） × 10^9/L, （0. 22 ±0. 36）×10^9/L; percentage of eosinophils were （17.35 ±8.50）%, （2. 95± 4.90）%; total immunoglobulin E were （750. 95 ± 1040. 11 ）, （343.87±489. 53 ） U·mL^-1 ; C reactive protein were （44. 44± 37.65 ）, （ 17.80 ± 13.29） mg·L^-1 ;erythrocyte sedimentation rates were （58.25 ±40.61）, （23.55 ± 10. 34） mm·h^-1. Five - factors score （FFS） showed that higher scores meant more recurrence, which meant bad long- term effectiveness. Conclusion Important organ involvement indicated poor efficacy of long - term glucocortieoid treatment, which required immunosuppressants therapy as early as possible in order to reduce the recurrence.

关 键 词：嗜酸细胞肉芽肿性多血管炎 糖皮质激素 受累器官 

分 类 号：R977.1[医药卫生—药品]