目的 探討環(huán)磷酰胺聯(lián)合小劑量沙利度胺對人類白細(xì)胞抗原-B51（HLA-B51）陰性/陽性白塞病的療效及對患者血液流變學(xué)指標(biāo)的影響。方法 回顧性分析2018年5月—2020年3月于中國科學(xué)技術(shù)大學(xué)附屬第一醫(yī)院（安徽省立醫(yī)院）治療的120例白塞病患者的臨床資料，根據(jù)治療方式將患者分為對照組和試驗(yàn)組，每組各60例。對照組患者給予沙利度胺片口服治療，50 mg/次，1次/d，晚上服用。試驗(yàn)組患者在對照組治療基礎(chǔ)上聯(lián)合環(huán)磷酰胺片口服治療，起始劑量為200 mg/次，1次/d，根據(jù)患者病情減量，減至50 mg/次，1次/d，維持治療。兩組患者均進(jìn)行1年的治療。比較兩組患者治療前后血液流變學(xué)指標(biāo)及炎癥因子水平變化，觀察兩組患者臨床療效及主癥有效率變化，以及不良反應(yīng)發(fā)生情況。結(jié)果 經(jīng)過1年的藥物治療，試驗(yàn)組患者的治療總有效率為90.00%，明顯高于對照組的73.33%，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后試驗(yàn)組患者關(guān)節(jié)炎、眼炎、口腔潰瘍等主要癥狀有效率均明顯高于對照組（P<0.001）。與治療前相比，治療后兩組患者血清白細(xì)胞介素-8（IL-8）、IL-6、腫瘤壞死因子-α（TNF-α）及C反應(yīng)蛋白（CRP）水平均顯著降低（P<0.001），血液流變學(xué)指標(biāo)紅細(xì)胞聚集指數(shù)（AI）、血漿黏度（ηP）、全血低切黏度（ηbL）、全血高切黏度（ηbH）均明顯降低（P<0.001），且試驗(yàn)組上述指標(biāo)改善效果較對照組顯著（P<0.001）。兩組患者不良反應(yīng)發(fā)生率無明顯差異（P>0.05）。結(jié)論 環(huán)磷酰胺聯(lián)合小劑量沙利度胺治療白塞病，可以明顯改善患者臨床癥狀及血液流變學(xué)指標(biāo)，減輕機(jī)體炎癥反應(yīng)，療效顯著。

Objective To investigate the effect of cyclophosphamide combined with low-dose thalidomide on human leukocyte antigen-B51 (HLA-B51) negative/positive Behcet's disease and its effect on hemorheological indexes. Methods The clinical data of 120 patients with Behcet's disease treated in the First Affiliated Hospital of China University of Science and Technology (Anhui Provincial Hospital) from May 2018 to March 2020 were analyzed retrospectively. According to the treatment method, the patients were divided into control group and experimental group, with 60 cases in each group. Patients in the control group were given Thalidomide Tablets orally, 50 mg/time, once a day, in the evening. On the basis of the treatment of the control group, the patients in the experimental group were treated with Cyclophosphamide Tablets orally. The initial dose was 200 mg/time, once a day. According to the patient's condition, it was reduced to 50 mg/time, once a day for maintenance treatment. Both groups were treated for one year. The changes of hemorheological indexes and inflammatory factors before and after treatment were compared between two groups, and the changes of clinical efficacy, effective rate of main symptoms, and incidence of adverse reactions were observed. Results After one year of drug treatment, the total effective rate of the experimental group was 90.00%, which was significantly higher than 73.33% of the control group (P<0.05). After treatment, the effective rates of arthritis, ophthalmia and oral ulcer in the experimental group were significantly higher than those in the control group (P<0.001). Compared with before treatment, serum interleukin-8 (IL-8), IL-6 and tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) in two groups after treatment were significantly decreased (P<0.001), hemorheological indexes, such as erythrocyte aggregation index (AI), plasma viscosity(ηP), low shear viscosity of whole blood(ηBL), and whole blood high shear viscosity (ηBH) were significantly decreased (P<0.001), and the improvement effect of the above indexes in the experimental group was significantly higher than that in the control group (P<0.001). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Cyclophosphamide combined with low-dose thalidomide in the treatment of Behcet's disease can significantly improve the clinical symptoms and hemorheological indexes, reduce the inflammatory reaction of the body, and has a significant effect.

R979.5

國家自然科學(xué)基金資助項(xiàng)目（8187060147）