1例甲氨蝶呤联合地塞米松鞘内注射治疗神经精神性狼疮的用药分析
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摘要
临床药师参与了1例神经精神性狼疮患者药物治疗方案的制定,分析了患者癫痫症状复发原因,通过查阅文献对神经精神性狼疮治疗方案及甲氨蝶呤联合地塞米松鞘内注射的治疗疗效和不良反应进行汇总梳理,建议治疗组选用甲氨蝶呤联合地塞米松鞘内注射的替代治疗方案并进行相关用药监护。患者鞘内注射甲氨蝶呤及地塞米松后,无严重不良反应,未再发癫痫,病情好转出院。临床药师参与医疗团队,协助治疗组制定药物治疗方案,并进行药物监护,对临床合理用药起到了一定作用。
Clinical pharmacists participated in the treatment of 1 patient with neuropsychiatric lupus erythematosus, and analyzed the cause of epilepsy recurrence. We summarized the treatment of neuropsychiatric lupus and the efficacy and adverse reaction of intrathecal injection with methotrexate and dexamethasone through literature review, and recommended intrathecal injection with methotrexate and dexamethasone as an alternative treatment, with pharmaceutical care. After the intrathecal injection of methotrexate and dexamethasone, the patient was improved and discharged without adverse reaction and epilepsy recurrence. By cooperating with physicians to optimize treatment and offer pharmaceutical care, clinical pharmacists play an important role in clinical rational drug use.
Clinical pharmacists participated in the treatment of 1 patient with neuropsychiatric lupus erythematosus, and analyzed the cause of epilepsy recurrence. We summarized the treatment of neuropsychiatric lupus and the efficacy and adverse reaction of intrathecal injection with methotrexate and dexamethasone through literature review, and recommended intrathecal injection with methotrexate and dexamethasone as an alternative treatment, with pharmaceutical care. After the intrathecal injection of methotrexate and dexamethasone, the patient was improved and discharged without adverse reaction and epilepsy recurrence. By cooperating with physicians to optimize treatment and offer pharmaceutical care, clinical pharmacists play an important role in clinical rational drug use.
引文
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[7]Efthimiou P,Blanco M. Pathogenesis of neuropsychiatric systemic lupus erythematosus and potential biomarkers[J].Mod Rheumatol,2009,19(5):457-468.
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[9]张真,肖岚,曾秋明,等.累及中枢神经系统的神经精神狼疮临床分析[J].中国现代神经疾病杂志,2013,13(1):43-48.
[10]Bertsias GK,Boumpas DT. Pathogenesis,diagnosis and management of neuropsychiatric SLE manifestations[J].Nat Rev Rheumatol,2010,6(6):358-367.
[11]陆慧,郑昕,胡蓓,等.甲泼尼龙琥珀酸钠、环磷酰胺、甲氨蝶呤穿透神经精神狼疮患者血脑屏障的能力[J].中华临床免疫和变态反应杂志,2014,8(1):57-62.
[12]周明倩,汪梅姣,温成平,等.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[J].南京医科大学学报(自然科学版),2017,37(6):779-784.
[13]Xuan Z,Yi D,Fu-Lin T,et al. Management of neuropsychiatricsystemiclupuserythematosus:current approaches and future perspectives[J]. J Clin Rheumatol,1999,5(6):314-319.
[14]周惠琼,冷晓梅,张奉春.神经精神狼疮患者240例的临床特点、治疗及预后分析[J].中华医学杂志,2006,86(11):771-774.
[15]郑朝恩,刘昱岑,杨娴,等.鞘内注射甲氨蝶呤加地塞米松治疗神经精神狼疮的临床分析[J].云南医药,2015,36(4):426-427.
[16]张莉芸,李小峰,王来远,等.小剂量甲氨蝶呤鞘内注射治疗系统性红斑狼疮中枢神经系统病变临床观察[J].山西临床医药杂志,2002,11(6):436-437.
[2]Magro-Checa C,Zirkzee EJ,Huizinga TW,et al. Management of neuropsychiatric systemic lupus erythematosus:current approaches and future perspectives[J]. Drugs,2016,76(4):459-483.
[3]谢长好,廖翔,孙凌云,等.神经精神狼疮自身免疫发病机制[J].中国现代神经疾病杂志,2014,14(9):769-774.
[4]中华医学会风湿病学分会.系统性红斑狼疮诊断及治疗指南[J].中华风湿病学杂志,2010,14(5):342-346.
[5]中国系统性红斑狼疮研究协作组专家组.糖皮质激素在系统性红斑狼疮患者合理应用的专家共识[J].中华内科杂志,2014,53(6):502-504.
[6]Dall’Era M. Mycophenolate mofetil in the treatment of systemic lupus erythematosus[J]. Curr Opin Rheumatol,2011,23(5):454-458.
[7]Efthimiou P,Blanco M. Pathogenesis of neuropsychiatric systemic lupus erythematosus and potential biomarkers[J].Mod Rheumatol,2009,19(5):457-468.
[8]Sanna G,Bertolaccini ML,Mathieu A. Central nervous system lupus:a clinical approach to therapy[J]. Lupus,2003,12(12):935-942.
[9]张真,肖岚,曾秋明,等.累及中枢神经系统的神经精神狼疮临床分析[J].中国现代神经疾病杂志,2013,13(1):43-48.
[10]Bertsias GK,Boumpas DT. Pathogenesis,diagnosis and management of neuropsychiatric SLE manifestations[J].Nat Rev Rheumatol,2010,6(6):358-367.
[11]陆慧,郑昕,胡蓓,等.甲泼尼龙琥珀酸钠、环磷酰胺、甲氨蝶呤穿透神经精神狼疮患者血脑屏障的能力[J].中华临床免疫和变态反应杂志,2014,8(1):57-62.
[12]周明倩,汪梅姣,温成平,等.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[J].南京医科大学学报(自然科学版),2017,37(6):779-784.
[13]Xuan Z,Yi D,Fu-Lin T,et al. Management of neuropsychiatricsystemiclupuserythematosus:current approaches and future perspectives[J]. J Clin Rheumatol,1999,5(6):314-319.
[14]周惠琼,冷晓梅,张奉春.神经精神狼疮患者240例的临床特点、治疗及预后分析[J].中华医学杂志,2006,86(11):771-774.
[15]郑朝恩,刘昱岑,杨娴,等.鞘内注射甲氨蝶呤加地塞米松治疗神经精神狼疮的临床分析[J].云南医药,2015,36(4):426-427.
[16]张莉芸,李小峰,王来远,等.小剂量甲氨蝶呤鞘内注射治疗系统性红斑狼疮中枢神经系统病变临床观察[J].山西临床医药杂志,2002,11(6):436-437.