摘要目的探讨鞘内联合注射甲氨喋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24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喋呤加地塞米松各10-20?mg,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 22例CNS、SLE临床症状体征缓解,有效率91.7%;鞘注前脑脊液压力、蛋白及白细胞分别为221.5±155.4?mm?H2O、105.2±87.6?mg/dl及16.7±14.3个/mm3,而鞘注后分别下降为148.7±108.1?mm?H2O、73.5±38.3?mg/dl及4.9±2.1个/mm3;4例出现过不良反应,如双下肢烧灼感、头痛或大小便失禁. 结论鞘内联合注射甲氨喋呤加地塞米松是治疗CNS、SLE 一种有效方法,值得进一步临床研究.

abstractsAbstract:Objective To investigate the effect of intrathecal injection (IT) with methotrexate (MTX) plus dexamethasone (DXM) in treating central nervous system involvement in systemic lupus erythematosus (CNS lupus). Methods Twenty-four CNS lupus patients that were refractory to conventional steroid therapy were selected for IT with MTX 10-20?mg plus DXM 10-20?mg. The effects and side effects of IT were closely observed. Results The symptoms and signs of 22/24 (91.7%) CNS lupus patients receiving IT improved considerably. Cerebrospinal fluid pressure,protein and WBC levels declined from 201.5±155.4?mm?H2O, 145.2±87.6?mg/dl and 25.1±14.3/mm3 to 128.7±108.1?mm?H2O, 60.8±38.3?mg/dl and 6.8±2.1/mm3 respectively. Transient side effects were observed in 4 patients: 1 with itching sensation of lower limbs, 2 with headache and 1 with incontinence.Conclusion IT with MTX plus DXM is a promising method for treating CNS lupus and deserves further investigation.