甲氨喋呤治疗结节病3例并文献复习
Methotrexate treatment of sarcoidosis:three cases report and review of literature
目的 通过对3例甲氨喋呤(MTX)治疗结节病的病例分析,深入了解MTX在结节病治疗中的作用.方法 回顾性分析3例接受MTX治疗的结节病患者的治疗效果和转归,通过文献复习,深入了解MTX在结节病治疗中的作用.结果 3例均为Ⅱ期肺结节病伴多脏器受累(分别累及肝脾、肾脏和眼部),其中2例初始强的松治疗有效,但在减量过程中出现反复,加用MTX后好转,另1例初始强的松治疗无效,加用MTX后出现肝损害,停药并调整强的松剂量后临床痊愈.治疗过程中,2例出现消化道症状、肝功能异常,1例继发感染导致死亡.结论 MTX可用于难治性结节病和需要长期大剂量皮质激素治疗的结节病患者,治疗过程中应监测其副作用.
更多Objective To introduce the treatment for refractory sarcoidosis patients with methotrexate (MTX).Methods The clinical presentations,course and outcome of 3 cases of sarcoidosis treated with MTX were reported.Literatures concering MTX treatment sarcoidosiswas reviewed,Results All of 3 patients had lungs and extrathoracic involved.Two patients were improved with initially treatment with prednisone,but deteriorated while prednisone is tapered.They made progress when MTX was added.One patient misused MTX and was crued with prednisone.In those patients,two suffered fromgastro-intestinal symptom and hepatotoxicity with MTX.One passed away for severe infection.Conclusions MTX could be used to patients with refractory disease and those who have to take long-term high dose of prednisone.Side effects should be warned when MTX used.
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