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目的 探讨鞘内联合注射甲氨蝶呤加地塞米松在治疗系统性红斑狼疮 (SLE)中枢神经系统 (CNS)病变中的作用。方法 对 2 4例常规剂量糖皮质激素治疗无效的CNS、SLE患者予鞘内联合注射甲氨蝶呤加地塞米松各 10～ 2 0mg ,对其临床疗效及副作用进行观察 ,并对鞘内注射治疗前后CNS、SLE住院死亡率进行比较。结果 2 2例CNS、SLE临床症状体征缓解 ,有效率 91 7% ;鞘内注射前脑脊液压力、蛋白及白细胞分别为 (2 0 2± 15 5 )mmH2 O、(145 2± 876 )mg/L及 (2 5 1± 14 3)× 10 6/L ,而鞘内注射后分别下降为 (12 9± 10 8)mmH2 O、(6 0 8± 383)mg/L及 (6 8± 2 1)× 10 6/L ,P均 <0 0 5 ;4例出现一过性不良反应 ,如双下肢烧灼感、头痛及一过性大小便失禁 ;鞘内注射前后CNS、SLE住院死亡率分别为 30 2 (2 9/ 96例 )及 4 0 % (3/ 75例 ) ,P <0 0 1。结论 鞘内联合注射甲氨蝶呤加地塞米松是治疗CNS、SLE的一种有效方法 ,值得进一步临床研究。
Objective To investigate the effect of intrathecal injection of methotrexate and dexamethasone in the treatment of central nervous system (CNS) in patients with systemic lupus erythematosus (SLE). Methods Twenty-four patients with CNS and SLE who were ineffective in conventional glucocorticoid therapy were injected intraperitoneally with 10-20 mg of methotrexate plus dexamethasone, respectively. The clinical effects and side effects were observed. The effects of intrathecal injection Before and after CNS, SLE hospital mortality were compared. Results The symptom of clinical symptoms of CNS and SLE was relieved in 21 cases, with an effective rate of 91.7%. Cerebrospinal fluid pressure, protein and white blood cells before intrathecal injection were (202 ± 155) mmH2O, (145 2 ± 876) mg / L And (2 5 1 ± 14 3) × 10 6 / L, respectively, but decreased to (12 9 ± 10 8) mmH 2 O, (6 0 8 ± 38 3) mg / L and (6 8 ± 2 1 ) × 10 6 / L, all P <0 05. Four patients had transient adverse reactions such as burning, headache and incontinence in both lower extremities. The in-hospital mortality rates of CNS and SLE before and after intrathecal injection were 30 2 (29/96) and 40% (3/75), P <0.01. Conclusion Intrathecal injection of methotrexate plus dexamethasone is an effective method for the treatment of CNS and SLE, which is worth further clinical study.