[一例高剂量甲氨蝶呤成功治疗难治性韦格纳肉芽肿病的病例]

[A case of refractory Wegener's granulomatosis successfully treated with high-dose methotrexate].

作者信息

Shimizu Takashi, Shimizu Natsue, Takada Toshinori, Gejyo Fumitake, Hasegawa Takashi, Suzuki Eiichi

机构信息

Division of Respiratory Medicine.

出版信息

Nihon Kokyuki Gakkai Zasshi. 2006 Nov;44(11):853-7.

PMID:17144586

Abstract

We report a case of generalized Wegener's granulomatosis (WG) successfully treated with high-dose methotrexate (MTX) and predonisolone (PSL). A 35 year-old men had complaints of auditory disturbance and nasal hemorrhage. Diagnosis of WG was made based on positive proteinase-3 anti-neutrophil cytoplasmic antibody (PR3-ANCA), lung nodules, and focal necrotizing glomerulonephritis revealed by renal biopsy. Treatment with cyclophosphamide (CY) and PSL for 3 months was ineffective for the lung nodules. Then, CY was changed to high dose MTX (18mg/week), and his lung lesions improved. In Japan, it is unusual to treat WG with high-dose MTX, but this treatment may be useful in CY-resistant WG.

摘要

我们报告一例经大剂量甲氨蝶呤（MTX）和泼尼松龙（PSL）成功治疗的广泛性韦格纳肉芽肿（WG）病例。一名35岁男性主诉听觉障碍和鼻出血。基于蛋白酶3抗中性粒细胞胞浆抗体（PR3-ANCA）阳性、肺结节以及肾活检显示的局灶性坏死性肾小球肾炎确诊为WG。使用环磷酰胺（CY）和PSL治疗3个月对肺结节无效。随后，将CY更换为大剂量MTX（18mg/周），其肺部病变得到改善。在日本，用大剂量MTX治疗WG并不常见，但这种治疗方法可能对CY耐药的WG有用。