小剂量阿维A与MTX联合治疗重症寻常型银屑病随机对照研究

Efficacy and safety of lower dose of acitretin and MTX in the treatment of severe psoriasis vulgaris

目的:观察小剂量阿维A与甲氨蝶呤(MTX)联合治疗重症寻常型银屑病的疗效与不良反应。方法:观察组:阿维A0.3mg(kg·d),MTX2.5mg,12h1次,每周连服3次,辅以叶酸5mgd,维生素E300mgd,用药6周。对于6周内临床治愈的病人,先停用MTX,阿维A减半维持治疗2周,停药。对照组1:阿维A0.3mg(kg·d),3～5d后加至0.5mg(kg·d),叶酸和维生素E同观察组,用药6周;对照组2:MTX5mg,12h1次,每周连服3次,叶酸和维生素E同观察组,用药6周。结果:观察组、对照组1和对照组2的有效率分别为96.23%、65.54%和66.67%。三组相比有显著性差异(χ2=9.97,P<0.01)。三组间不良反应发生率分别为11.32%、33.33%和27.27%,有显著性差异(χ2=8.67,P<0.05)。结论:小剂量阿维A与小剂量MTX联合治疗重症寻常型银屑病疗效好,不良反应发生率低。

Objective： To investigate the efficacy and adverse reactions of the combination therapy of lower dose of acitretin and methotrexate （MTX） in the treatment of severe psoriasis vulgaris. Methods： The patients in the study group took lower dose of acitretin （0.3 mg/kg·d） and MTX 2.5 mg, once every 12 hours for consecutive 3 times, supplemented by oral folic acid 5 mg/d and vitamin E 300 mg/d. On week 6 after treatment, the clinically cured patients stopped taking MTX, and took half dose of acitretin for 2 weeks, and then, stopped all the medicines. The control group 1 took acitretin （0.3 mg/kg·d） for 3 - 5 days, followed by 0.5 mg/（kg·d）, and supplemented by folic acid 5mg/d and vitamin E 300 mg/d. The control group 2 took MTX 5 mg, once every 12 hours, thrice weekly, and supplemented by folic acid 5 mg/d and vitamin E 300 mg/d. Results： The response rates in the study group, control group 1 and control group 2 were 96.23 %, 65.54% and 66.67 %, respectively, with a significant difference in the three groups （ χ^2 = 9.97, P 〈 0.01 ）. The numbers of drug adverse reactions in the three groups were 6, 19 and 15, respectively, with significant differences in the three groups （ χ^2 = 8.67, P 〈 0.05）. Conclusion： The combination of lower dose of acitretin and MTX in the treatment of severe psoriasis vulgaris is effective and safe.