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目的探讨甲氨蝶呤联合氟美松鞘内注射治疗系统性红斑狼疮(SLE)中枢神经系统损害的效果。方法对28例鞘内注射的SLE中枢神经系统损害患者治疗前后的临床表现、脑脊液、头颅CT或磁共振成像(MRI)进行对比分析,并与57例未行鞘内注射者的情况进行对照。结果28例患者中2例死亡,其他患者病情均明显改善或完全缓解;脑脊液压力明显下降,蛋白水平降低,糖升高,但差异无统计学意义;6例抗核抗体(ANA)阳性者全部转阴。结论甲氨蝶呤联合氟美松鞘内注射治疗SLE中枢神经系统损害有明显效果,尤其是有定位表现者,能提高抢救成功率,副作用轻且少,值得临床推荐使用。
Objective To investigate the effect of methotrexate combined with dexamethasone intrathecal injection on the central nervous system damage of systemic lupus erythematosus (SLE). Methods The clinical manifestations, cerebrospinal fluid (CSF), cranial CT or magnetic resonance imaging (MRI) of 28 cases of intrathecal SLE patients with CNS injury before and after intrathecal injection were compared with those of 57 cases without intrathecal injection. Results Two of the 28 patients died, and the other patients were significantly improved or completely relieved. The cerebrospinal fluid pressure decreased obviously, while the protein level decreased and the sugar increased, but the difference was not statistically significant. All 6 patients with positive anti-nuclear antibody (ANA) Negative. Conclusion The combination of methotrexate and dexamethasone intrathecal injection has significant effect on the central nervous system damage of SLE. Especially in those with locating performance, the success rate of salvage can be improved with less side effects and less deserving of clinical recommendation.