Stanziola A, Sofia M, Mormile M, Molino A, Carratù L
Clinica di Malattie dell'Apparato Respiratorio, Facoltà di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, Italy.
Monaldi Arch Chest Dis. 1995 Apr;50(2):109-13.
Controlled short-term studies (< 6 months) have yielded conflicting results as to the steroid-sparing effect of methotrexate (MTX) and its effectiveness in treating patients with chronic corticosteroid-dependent asthma (CDA). In an open study, we treated 13 patients with MXT (7.5-20 mg.week-1) for > or = 12 months (range 54-72 weeks). After 12 weeks of treatment, the intake of steroids had fallen by 36 +/- 22% (mean +/- SD); the clinical score was not significantly different from baseline (1.7 +/- 0.44 vs 1.4 +/- 0.52). At 52 weeks, steroid intake was reduced by 87 +/- 23% and 9 of the 13 patients no longer required corticosteroids. Moreover, both the clinical and functional scores were significantly better with respect to run-in values forced expiratory volume in one second (FEV1) 75 +/- 6 vs 60 +/- 10% predicted; forced vital capacity (FVC) 84 +/- 10 vs 77 +/- 13% pred; arterial oxygen tension (PaO2) 11.3 +/- 1.0 vs 10.7 +/- 1.3 kPa (84.5 +/- 7.8 vs 80.6 +/- 9.6 mmHg). No serious side-effects were recorded during the study; transaminase levels were increased in 62% of cases. In patients affected by chronic corticosteroid dependent asthma, the steroid-sparing effects of methotrexate and clinical improvement were apparent after 6 months treatment.
关于甲氨蝶呤（MTX）的激素节省效应及其治疗慢性皮质类固醇依赖型哮喘（CDA）患者的有效性，短期对照研究（<6个月）得出了相互矛盾的结果。在一项开放性研究中，我们对13例患者使用甲氨蝶呤（7.5 - 20mg·周⁻¹）治疗≥12个月（范围54 - 72周）。治疗12周后，类固醇摄入量下降了36±22%（均值±标准差）；临床评分与基线相比无显著差异（1.7±0.44对1.4±0.52）。在52周时，类固醇摄入量减少了87±23%，13例患者中有9例不再需要使用皮质类固醇。此外，临床和功能评分相对于基线值均有显著改善：一秒用力呼气量（FEV1）为预测值的75±6%对60±10%；用力肺活量（FVC）为预测值的84±10%对77±13%；动脉血氧分压（PaO2）为11.3±1.0kPa对10.7±1.3kPa（84.5±7.8mmHg对80.6±9.6mmHg）。研究期间未记录到严重副作用；62%的病例转氨酶水平升高。在慢性皮质类固醇依赖型哮喘患者中，甲氨蝶呤的激素节省效应和临床改善在治疗6个月后明显。
