阿维A联合血管扩张剂治疗6例系统性硬皮病疗效观察

Acitretin in combination with vasodilators in the treatment of six patients with systemic sclerosis

目的:观察阿维A联合血管扩张剂治疗系统性硬皮病(SSc)的疗效和安全性。方法:收集2000—2005年住院和门诊就诊的6例SSc患者,主要使用阿维A0.5～0.6mg/(kg·d)和扩张血管药物等治疗。皮肤受累程度采用改良的Rodnan评分法评估,治疗后评分减少75%以上为临床显效。结果:6例患者中有5例伴有关节疼和雷诺征(83.33%),另1例伴有吞咽困难(16.67%),均无其他内脏受累;治疗前皮肤硬化程度评分平均为(22.00±6.96)分(12～30分)。治疗2周后,所有患者的关节疼、雷诺征及吞咽困难逐渐缓解,部分患者面部等处皮肤开始变软;8周后,所有患者的皮肤症状改善,皮肤硬化程度平均评分下降至(7.17±3.92)分(2～12分),与治疗前比较差异有统计学意义(P<0.05)。4例患者疗效显著,2例患者在治疗2周后出现肝功能异常、血脂升高。结论:阿维A联合血管扩张剂治疗SSc有效。

Objective： To observe the efficacy of acitretin in combination with vasodilators in the treatment of systemic sclerosis（SSc）. Methods： Six in-patients and out-patients with SSc from 2000 to 2005 were analyzed. All patients were treated with acitretin 0.5-0.6 mg/（kg·d） in combination with vasodilators. Skin thickness and hardness were assessed by using the modified Rodnan score, of which reduction of more than 75% was defined as significant improvement. Results： In 6 SSc patients, 5 （83.33%） of them were accompanied by arthralgia and Raynaud＇s phenomenon, 1 case （16.67%） with dysphasia, no symptoms and signs suggesting other internal organs involved. Rodnan score ranged from 12 to 30（22.00±6.96） before treatment. After the combination therapy, all the clinical symptoms and signs of the patients improved. The Rodnan score decreased after 2 weeks, and continued to decrease. By the end of the 8th week, the Rodnan score was 2-12（7.17±3.92）, which showed statistical difference compared with that of the pre-treatment（P 〈 0.05）. Four cases showed marked improvement, while 2 cases developed abnormal liver function and hyperlipidemia, which had no influence on the continuation of therapy. Conclusion： The preliminary study suggests that acitretin in combination with vasodilators be the choice of treatment for SSc.