药物联合治疗成人多发性肌炎/皮肌炎的临床分析  

Clinical analysis of drug combination therapy in the treatment adult polymyositis/dermatomyositis

作　　者：郝英利 王良民 杨晶露 张士发 HAO Yingi;WANG Liangmin;YANG Jingu;ZHANG Shifa(Department of Dermatology,Northeast International Hospital,Shenyang,Liaoning,110623,China)

机构地区：[1]东北国际医院皮肤科,辽宁沈阳110623

出　　处：《当代医学》2024年第6期147-150,共4页Contemporary Medicine

摘　　要：目的探讨药物联合治疗多发性肌炎/皮肌炎(PM/DM)的临床疗效。方法回顾性分析2002年6月至2017年5月东北国际医院收治的17例PM/DM患者的临床资料,所有患者均采用糖皮质激素、环磷酰胺、吗替麦考酚酯、硫酸羟氯喹、复方甘草酸苷制剂、卡介菌多糖核酸注射液联合治疗。分析药物使用剂量、治疗时间、治愈率、不良反应发生情况,比较治疗前后实验室检查指标,分析联合药物剂量、各种药物使用剂量与疗程关系。结果联合药物治疗时间为4~168个月,平均(91.00±15.56)个月;治愈率为100.0%;治疗期间患者出现体质量增加、满月脸、一过性白细胞降低、胃肠道反应,随访5年,患者除体质量增加外,其他不良反应均消失,未出现其他远期不良反应。治疗后,患者乳酸脱氢酶(LDH)、肌酸激酶(CK)、C反应蛋白(CRP)、红细胞沉降率(ESR)水平均低于治疗前,差异有统计学意义(P<0.05)。联合药物剂量与疗程有关(P<0.05);环磷酰胺、吗替麦考酚酯、复方甘草酸苷制剂及卡介菌多糖核酸注射液的使用剂量均与疗程有关(P<0.05),而糖皮质激素和羟氯喹的使用剂量与疗程无关。结论联合使用糖皮质激素、环磷酰胺、吗替麦考酚酯、硫酸羟氯喹、复方甘草酸苷制剂和卡介菌多糖核酸注射液治疗PM/DM效果确切,可降低患者LDH、CK、CRP和ESR水平,改善PM/DM患者病情转归,安全性较高,但糖皮质激素和硫酸羟氯喹需结合患者具体情况选择用药。Objective To investigate the clinical efficacy of drug combination in the treatment of polymyositis/dermatomyositis(PM/DM).Methods Clinical data of 17 PM/DM patients admitted to Northeast International Hospital from 2002 to 2017 were retrospectively analyzed,all pa-tients were treated with the combination of glucocorticoid,cyclophosphamide,mycophenolate mofetil,hydroxychloroquine sulphate,compound glyc-yrrhizin preparation and BCG polysaccharide nucleic acid injection.The drug dose,treatment time,cure rate and adverse reactions were analyzed,the laboratory test indexes before and after treatment were compared,and the relationship between combined drug dosage,various drug dosage and course of treatment was analyzed.Results The duration of combined drug treatment was 4-168 months,with an average of(91.00±15.56)months;the cure rate was 100.0%;during treatment,the patients showed increased body mass,full moon face,transient leukopenia,and gastrointestinal reac-tions.After 5 years of follow-up,all adverse reactions except body mass increase disappeared,and no other long-term adverse reactions occurred.Af-ter treatment,the levels of lactate dehydrogenase(LDH),creatine kinase(CK),C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were lower than those before treatment,and the differences were statistically significant(P<0.05).The combined drug dose was correlated with the course of treatment(P<0.05).The dosages of cyclophosphamide,mortemycophenolate,compound glycyrrhizin and BCG polysaccharide nucleic ac-id injection were correlated with the course of treatment(P<0.05),but the dosages of glucocorticoid and hydroxychloroquine sulphate were not cor-related with the course of treatment.Conclusion Combined use of glucocorticoid,cyclophosphamide,mycophenolate mofetil,hydroxychloroquine sulphate,compound glycyrrhizin preparation and BCG polysaccharide nucleic acid injection has a definite effect in the treatment of PM/DM,can re-duce the levels of LDH,CK,CRP and ESR,and can significantly improve the outcome of PM/D

关 键 词：多发性肌炎/皮肌炎 糖皮质激素 环磷酰胺 吗替麦考酚酯 硫酸羟氯喹 复方甘草酸苷 卡介菌多糖核酸注射液 

分 类 号：R685.2[医药卫生—骨科学]