摘要
目的探讨甲氨蝶呤(MTX)治疗儿童重度斑块型银屑病的疗效及对血清中炎症因子IL-17A、IL-23、TNF-α的影响。方法 18例儿童重度斑块型银屑病患者口服MTX每周0.1~0.3 mg/kg,治疗4~24周,以银屑病受累面积和严重程度(PASI)评分和儿童皮肤病生活质量指数(CDLQI)评分评价疗效;采用液相悬浮芯片法测定基线和治疗24周后患者血清中IL-17A、IL-23和TNF-α的水平。结果 18例儿童重度斑块型银屑病患者治疗4、8、12、24周后PASI评分较治疗前显著下降(P均<0.05);治疗4、8、12、24周后达到PASI75的患者比例分别为11.76%、40.00%、76.92%、100%。治疗12、24周后CDLQI的中位值较治疗前显著下降。9例患者治疗24周后血清中IL-17A、IL-23和TNF-α的水平较治疗前降低(P均<0.05)。不良反应有恶心、食欲减退、谷丙转氨酶及谷草转氨酶轻度升高。结论在医师严密的监测下,小剂量的MTX治疗儿童重度斑块型银屑病疗效良好,安全性较高,患者满意度高。随着疗效的提高,患者血清中炎症因子的水平逐渐降低。
Objective The study aims to evaluate the effectiveness of methotrexate(MTX)in the treatment of severe plaque psoriasis in children and to measure the serum levels of IL-17A,IL-23 and TNF-α in patients.Methods Eighteen pediatric severe plaque psoriasis patients were enrolled in this study.A single dose of 0.1~0.3 mg/kg MTX was prescribed once weekly for 4~24 weeks.The efficacy of MTX was evaluated by the psoriasis area-and-severity index(PASI)and children's dermatology life quality index(CDLQI).The baseline and the serum levels of IL-17A,IL-23,TNF-α after 24 weeks of MTX therapy were detected by liquid phase suspension chip.Results PASI score in MTX-treated patients significantly decreased at 4,8,12,24 weeks compared to baseline values(P<0.05).PASI75 at week 4,8,12,24,was achieved in 11.76%,40.00%,76.92%,100% patients,respectively.Median CDLQI decreased significantly at 12 and 24 weeks.After 24 weeks of MTX treatment,the serum concentrations of IL-17A,IL-23,TNF-α were lower than at baseline(P<0.05).The adverse events included nausea,loss of appetite,mildly elevated alanine aminotransferase and aspartate transaminase.Conclusion A low dose of MTX is effective and safe for severe pediatric plaque psoriasis under expert supervision.The reduction in serum concentrations of IL-17A,IL-23,TNF-α after MTX treatment indicates MTX therapeutic efficacy.
作者
顾洋
王召阳
向欣
徐子刚
GU Yang;WANG Zhaoyang;XIANG Xin;XU Zigang(Department of Dermatology and Venereology,Beijing Children's Hospital,Beijing 100045,China)
出处
《中国皮肤性病学杂志》
CAS
CSCD
北大核心
2019年第8期890-894,共5页
The Chinese Journal of Dermatovenereology
基金
北京市科委“首都临床特色应用研究”专项课题(Z161100000516070)
北京市自然科学基金资助项目(7174300)
北京市医院管理局临床医学发展专项(ZYLX 201601)
北京市医院管理局儿科学科协同发展中心专项经费资助(XTZD20180502)
