小剂量皮质激素在控制天疱疮复发中的应用

Recurrence control of pemphigus by corticosteroids with small dosage

[目的]探讨以小剂量皮质激素(corticosteroids, CS)辅以免疫抑制剂、免疫调节剂和(或)补肾中药控制口腔黏膜天疱疮复发的临床效果.方法:临床和病理检查确诊的天疱疮患者,经过急性期强的松(或地塞米松,下同)治疗,控制病情以后,逐渐减量.在病情稳定期,给予小剂量强的松维持并辅以雷公藤多甙、复方反应停胶囊(每胶囊含反应停30 mg)、复方环磷酰胺片(每片含环磷酰胺30 mg和人参总皂甙)、氨苯砜等和(或)补肾中药.强的松缓慢减量直至停药.25 例患者随访9～16 年.结果:停药后,未再复发16 例(占随访病例总数的64%)、轻度复发7 例(占28%)、重度复发2 例(占8%).均未出现严重的全身副作用.结论:小剂量CS维持较长时间,并辅以免疫抑制剂、免疫调节剂和(或)补肾中药,最后停用CS.在9～16 年的随访期间内,可有效地控制口腔黏膜天疱疮的复发,不产生严重的全身副作用.

Objective:To study the clinical effect of corticosteroids (C S) with small dosage in the recurrence control of pemphigus. Methods: 25 cases of pemphigus were diagnosed by clinical and pathological examinati on.They were treated with CS at 60-80 mg/d in acute stage for symptom control.Th en,the dosage of CS was decreased by 5 mg in each following 2 weeks untill it re ached 2.5 mg/2 d. The treatment of 2.5 mg/2 d was continued for 1 year and was a ssisted with tripterygium polyglycoside, compound thalidomide, compound cyclopho sphamide (compounded with total saponins of ginseng), dapsone, and/or some kidne y-supplementing herbs. The patients were followed-up for 9~16 years.Re sults:No recurrence was observed in 16 cases(64%).Recurrence was found i n 9 cases(36%),among them 7(28%) were with light symptom and 2(8%) severe. Sever e side-effect was not found in all cases. Conclusion:The recurr ence of pemphigus may be controlled without severe side-effect by long-term us e of small dosage of CS assisted with proper immuno-inhibitors, immuno-regulat ors and/or some kidney-supplementing herbs.