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目的探讨口服小剂量甲氨蝶呤在无明显脏器受累的系统性红斑狼疮(SLE)患者出现关节炎、皮疹中的疗效及安全性。方法 30例口服小剂量醋酸泼尼松联合小剂量硫酸羟氯喹治疗无明显脏器受累、病情轻中度活动期SLE患者,治疗≥3个月出现关节炎和(或)皮疹,将治疗方案调整为加用小剂量甲氨蝶呤,治疗3个月后回顾性分析治疗方案调整前后患者的皮疹发生率、关节肿胀数、关节压痛数、C反应蛋白(CRP)、红细胞沉降率(ESR)、补体C3、补体C4、系统性红斑狼疮疾病活动度评分表(SLEDAI)评分、激素平均用量及不良反应等指标。结果调整治疗方案后患者的皮疹发生率、关节肿胀数、关节压痛数、SLEDAI评分、激素平均用量均较调整治疗方案前明显改善,差异均有统计学意义(P<0.05)。调整治疗方案后患者的CRP、ESR、C3、C4与调整治疗方案前比较差异均无统计学意义(P>0.05)。治疗方案调整后30例患者中,3例出现头晕、恶心,可以耐受,2例出现转氨酶轻度增高(<正常上限2倍),1例出现白细胞计数轻度降低(>3.0×10~9/L),经过对症处理后完全缓解,治疗方案调整后无严重不良反应发生。结论小剂量甲氨蝶呤联合小剂量激素、硫酸羟氯喹治疗无明显脏器受累的SLE患者出现的关节炎、皮疹,疗效显著,安全性高。
Objective To investigate the efficacy and safety of low-dose methotrexate in the treatment of arthritis and rash in patients with systemic lupus erythematosus (SLE) without obvious organ involvement. Methods Thirty patients with mild and moderate active SLE were treated with low dose of prednisone acetate combined with low dose of hydroxychloroquine for treatment of arthritis and / or rash at ≥3 months. The treatment regimen was adjusted To add small doses of methotrexate, three months after treatment, the incidence of rash, joint swelling, joint tenderness, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) Complement C3, complement C4, systemic lupus erythematosus disease activity score (SLEDAI) score, the average amount of hormones and adverse reactions and other indicators. Results The incidence of skin rashes, joint swelling, joint tenderness, SLEDAI score and average hormone dosage were all significantly improved after adjusting the treatment regimen, with significant differences (P <0.05). There was no significant difference in CRP, ESR, C3, C4 between before and after adjustment of treatment regimen (P> 0.05). Of the 30 patients adjusted for treatment regimens, 3 developed dizziness, nausea, and tolerability, 2 had a mild increase in aminotransferases (<2 times the upper limit of normal), and 1 had mildly reduced white blood cell counts (> 3.0 × 10 -9 / L), after symptomatic treatment of complete remission, treatment program no serious adverse reactions after adjustment. Conclusion Low dose methotrexate combined with small dose of hormone and hydroxychloroquine sulfate in the treatment of arthritis and skin rash without obvious organ involvement is significant and safe.