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目的:观察吗替麦考酚酯治疗系统性红斑狼疮合并重度血小板减少的疗效和安全性。方法:系统性红斑狼疮合并重度血小板减少患者11例,激素常规及冲击治疗、大剂量免疫球蛋白治疗无效后,给予吗替麦考酚酯1.0~1.5 g/d,2次/d,口服。连用3个月后,有效者继续原剂量服用3个月后逐渐减量维持,无效者停药。观察治疗过程中及治疗6个月后血小板计数及药物不良反应,并评定治疗6个月后疗效。结果:1例治疗12 d后失访,2例因经济原因于治疗15 d后停药,余8例患者完成6个月治疗,显效2例,有效2例,进步1例,无效者3例;5例服用吗替麦考酚酯后第3周血小板计数开始增高,3例在服用5~11周后血小板计数升高,于治疗后16~23周到达峰值,且治疗效果与治疗前血小板计数水平无关。3例治疗7 d内出现轻度腹泻、腹痛和恶心,经减量和对症治疗后好转,完成6个月治疗;1例治疗第13天后出现白细胞减少,最低为2.6×109/L,口服升白细胞药物后好转;1例治疗1个月后出现轻微肝功损害;未见肾功能损害及其他严重不良反应。结论:吗替麦考酚酯治疗系统性红斑狼疮合并血小板减少疗效满意。
Objective: To observe the efficacy and safety of mycophenolate mofetil in the treatment of systemic lupus erythematosus complicated with severe thrombocytopenia. Methods: Eleven patients with systemic lupus erythematosus complicated with severe thrombocytopenia were treated with normal and shock hormone therapy and high dose of immunoglobulin. After treatment, mycophenolate mofetil 1.0 ~ 1.5 g / d was given orally twice a day. Used 3 months later, the effective continued to use the original dose of 3 months after gradual reduction of maintenance, ineffective withdrawal. Observe the course of treatment and 6 months after treatment, platelet count and adverse drug reactions, and evaluate the efficacy of 6 months after treatment. Results: One case was lost after 12 days of treatment, two cases were discontinued after 15 days due to economic reasons, the other 8 cases completed 6 months of treatment, two cases were markedly effective, two cases were effective, one case was improved, and three cases were ineffective ; 5 patients taking mycophenolate mifepristone 3 weeks after the platelet count began to increase in 3 cases took 5 to 11 weeks after the platelet count increased to 16 to 23 weeks after treatment peaked and the treatment effect with pre-treatment platelet The counting level has nothing to do. 3 cases of mild diarrhea within 7 days of treatment, abdominal pain and nausea, after reduction and symptomatic treatment and improvement, to complete the 6-month treatment; 1 case of leukopenia after the first 13 days, the lowest was 2.6 × 109 / L, oral l After leukocyte drugs improved; 1 case of mild liver damage after 1 month of treatment; no renal damage and other serious adverse reactions. Conclusion: Mycophenolate mofetil treatment of systemic lupus erythematosus with thrombocytopenia is satisfactory.