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目的探讨尼美舒利与甲氨蝶呤(MTX)联合治疗成人斯蒂尔病的疗效。方法成人斯蒂尔病23例,接受尼美舒利与甲氨蝶呤联合治疗方案:口服尼美舒利100mg,每12h1次;生理盐水40ml+MTX10mg,静脉注射,每周1次,4次后改为口服MTX10mg,每周1次。联合治疗3d,体温仍不下降者,加用泼尼松,每日10mg;治疗7d不降者,泼尼松改为每日30mg。运用生存分析的方法观察控制发热的时间和复发的时间;同时观察治疗前后血白细胞、血沉、C反应蛋白、血清铁蛋白4项实验室指标以及副反应。结果19例(82%)在用药后24h内体温恢复正常,2例在加用泼尼松10mg/d后控制发热,1例需要将泼尼松剂量增加到30mg/d。另有1例增加激素剂量无效,需加用环孢素A才能控制病情。3例病人在减药的过程中复发,另有1例在停药后复发。16例已经完全停药,疗程6~14个月,中位数11个月,5例只用MTX维持,疗程8~16个月,1例需要泼尼松30mg/d和另1例需要环孢素A治疗者,目前仍需MTX和泼尼松10mg/d维持。治疗后3个月15例(65%)和治疗后6个月19例(83%)4项实验室指标均恢复正常。全部病人在治疗初期均出现多汗现象,多汗持续5~36d,中位数8d,其中2例出现低血压需要临时静脉补液。2例出现轻度的丙氨酸转氨酶升高。结论尼美舒利与MTX联合治疗成人斯蒂尔病具有良好疗效。
Objective To investigate the efficacy of nimesulide and methotrexate (MTX) in the treatment of adult patients with Steller disease. Methods Twenty-three adult patients were treated with nimesulide and methotrexate: nimesulide 100 mg orally every 12h, saline 40ml + MTX 10mg intravenously once a week for 4 times After the change to oral MTX10mg, once a week. Combined treatment of 3d, body temperature is still not decreased, plus prednisone, daily 10mg; treatment 7d down, prednisone changed to 30mg daily. Survival analysis was used to observe the time of fever control and the time of relapse. At the same time, 4 laboratory indexes of blood leucocyte, erythrocyte sedimentation rate, C-reactive protein and serum ferritin were observed before and after treatment. Results Nineteen (82%) patients returned to normal body temperature within 24 hours after treatment. Two patients were given fever after 10 mg / day of prednisone. One patient needed to increase the dose of prednisone to 30 mg / d. Another case of increased hormone dose ineffective, need to add cyclosporine A to control the disease. Three patients relapsed during the course of drug abatement, and another one recurred after discontinuation. Sixteen patients were completely discontinued. The course of treatment was 6 to 14 months with a median of 11 months. Five patients were only treated with MTX. The course of treatment was 8 to 16 months. One patient required prednisone 30 mg / d and the other required circulation Spiramycin A treatment, the current still need MTX and prednisone 10mg / d maintenance. Four laboratory indexes returned to normal after 15 months (65%) and 19 months (83%) after 3 months of treatment. All patients in the early treatment of hyperhidrosis appeared phenomenon, sweating lasted 5 ~ 36d, the median 8d, of which 2 cases of hypotension need temporary intravenous rehydration. 2 cases of mild alanine aminotransferase increased. Conclusion Nimesulide combined with MTX treatment of adult patients with Steller disease has a good effect.