低剂量甲氨蝶呤单药治疗结节病的有效性
Usefulness of low-dose methotrexate monotherapy for treating sarcoidosis.
作者信息
Isshiki Takuma, Yamaguchi Tetsuo, Yamada Yoshihito, Maemura Keita, Makita Kosuke, Takeshima Hideyuki, Hirasawa Yasutaka, Yamaguchi Yoko, Hosoki Keisuke, Suzuki Mika, Kono Chiyoko, Terada Jiro, Tatsumi Koichiro
机构信息
Department of Chest Medicine, Japan Railway Tokyo General Hospital, Japan.
出版信息
Intern Med. 2013;52(24):2727-32. doi: 10.2169/internalmedicine.52.0976.
OBJECTIVE
Methotrexate (MTX) is a cytotoxic agent that is commonly employed as an alternative to corticosteroids to treat sarcoidosis, although the proper use and efficacy of MTX as a single agent remain unclear.
METHODS
The clinical records of patients newly diagnosed with sarcoidosis who were admitted to our institution between 2000 and 2009 were reviewed. Among these patients, 26 received 7.5 mg of MTX per week as a single agent, and the independent effects of MTX were analyzed.
RESULTS
Six of the 26 patients (23%) exhibited an improvement of sarcoidosis-related lesions. The skin lesions demonstrated a relatively higher response rate (37%) than the pulmonary lesions (9%). Ten of the 26 patients (39%) experienced adverse effects, mostly mild hepatotoxicity. No severe adverse effects, including irreversible hepatotoxicity, were observed.
CONCLUSION
Although the efficacy of low-dose MTX monotherapy for sarcoidosis in this study was not high (23%), some patients exhibited definite improvements, and the drug proved to be safe, suggesting its possible benefits as a single agent for treating sarcoidosis.
目的
甲氨蝶呤（MTX）是一种细胞毒性药物，常用于替代皮质类固醇治疗结节病，但其作为单一药物的正确用法及疗效尚不清楚。
方法
回顾了2000年至2009年间我院收治的新诊断结节病患者的临床记录。其中，26例患者每周接受7.5毫克MTX单药治疗，并分析MTX的独立作用。
结果
26例患者中有6例（23%）结节病相关病变有所改善。皮肤病变的缓解率（37%）相对高于肺部病变（9%）。26例患者中有10例（39%）出现不良反应，主要为轻度肝毒性。未观察到包括不可逆肝毒性在内的严重不良反应。
结论
尽管本研究中低剂量MTX单药治疗结节病的疗效不高（23%），但部分患者有明确改善，且该药安全，提示其作为治疗结节病的单一药物可能有益。
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