鞘内注射甲氨蝶呤与地塞米松联合口服激素治疗神经精神性狼疮的系统评价

发布时间：2018-07-02 19:24

本文选题：鞘内注射 + 甲氨蝶呤　；参考：《南京医科大学学报(自然科学版)》2017年06期

【摘要】：目的:评价鞘内注射甲氨蝶呤(methotrexate,MTX)与地塞米松(dexamethasone,DXM)联合口服激素在神经精神性狼疮(neuropsychiatric systemic lupus erythematosus,NPSLE)治疗中的效果。方法:全面检索1996年1月—2016年12月关于鞘内注射MTX与DXM治疗NPSLE的临床试验文献,采用激素或激素联合环磷酰胺治疗作为对照组,鞘内注射MTX与DXM联合口服激素治疗作为治疗组的随机对照试验进行meta分析。结果:纳入6项研究,256例NPSLE,对照组和试验组的例数分别为126例和130例。meta分析结果显示,治疗组在降低系统性红斑狼疮疾病活动度评分(systemic lupus erythematosus disease activity index,SLEDAI)方面均优于对照组(P0.01);并且脑脊液压力、脑脊液蛋白、血沉等相关指标,治疗组均低于对照组(P0.01)。结论:鞘内注射MTX与DXM联合口服激素的效果优于单纯口服激素;但是由于文献的方法学质量较低,仍需要高质量、大样本、多中心的随机临床试验加以验证。
[Abstract]:Objective: to evaluate the efficacy of intrathecal injection of methotrexate (MTX) and dexamethasone (DXM) in the treatment of (neuropsychiatric systemic lupus erythematosus NPSLE. Methods: the clinical trials of intrathecal injection of MTX and DXM in the treatment of NPSLE from January 1996 to December 2016 were searched. The control group was treated with hormone or hormone combined with cyclophosphamide. Intrathecal injection of MTX and DXM combined with oral hormone therapy was used as a randomized controlled trial in the treatment group for meta analysis. Results: among the 256 NPSLEs in 6 studies, 126 cases in the control group and 130 cases in the trial group were analyzed by meta analysis. The treatment group was superior to the control group in reducing the activity of systemic lupus erythematosus (systemic lupus erythematosus disease activity index SLEDAI), and the cerebrospinal fluid pressure, cerebrospinal fluid protein, erythrocyte sedimentation rate and other related indexes were lower in the treatment group than in the control group (P0.01). Conclusion: the efficacy of intrathecal injection of MTX and DXM combined with oral hormone is better than that of oral hormone alone, but due to the low methodological quality of the literature, high quality, large sample and multi-center randomized clinical trials are still needed to verify it.
【作者单位】：浙江中医药大学基础医学院;
【基金】：浙江中医药大学科研基金(711200F029)
【分类号】：R593.241;R747.9

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