麦考酚酯与环孢素A治疗难治性泛发性脓疱型银屑病疗效比较

Efficacy Comparison between MMF and CsA in the Treatment of Refractory Generalized Pustular Psoriasis

目的观察麦考酚酯与环孢素A治疗难治性泛发性脓疱型银屑病的疗效及安全性。方法 24例难治性泛发性脓疱型银屑病患者随机分为A、B两组各12例。A组给予麦考酚酯治疗,B组给予环孢素A治疗,观察至少12周,比较两组的疗效、体温、皮疹消退情况、复发情况、不良反应并监测两种药物的血药浓度。结果两组疗效差异无统计学意义,但A组体温降至正常的时间以及皮疹消退的时间长于B组; B组有4例血压升高,A、B两组各1例伴感染; B组1例在减量中复发; A组1例疗效随着麦考酚酸曲线下面积(MPA-ACU)升高而变好,其余4例疗效好的患者均为MPA-ACU> 30(μg·h)/mL。结论治疗难治性泛发性脓疱型银屑病,环孢素A较麦考酚酯起效更快,麦考酚酯副作用更小,对于不能耐受环孢素A的患者可选用麦考酚酯,MPA-ACU也许可以反映疗效。

Objective To observe the efficacy and safety of mycophenolate mofetil(MMF)and CsA in the treatment of refractory generalized pustular psoriasis (GPP).Methods A total of 24 patients of refractory GPP were randomly divided into two groups,with 12 cases in each group.The patients of group A was treated with MMF,and those of group B were treated with CsA.The therapeutic efficacy,body temperature,the time when rash disappeared,recurrence,adverse reactions,and plasma concentration of the two drugs were observed and compared after at least 12 weeks.Results There was no significant difference in the efficacy between the two groups.However,the recovery time of body temperature and the time when rash subsided were longer in group A than in group B.Four patients in group B had elevated blood pressure,1 in group A and B had infection respectively.One case in group B had recurrence after dose reduction.Therapeutic effect in one case in group A became better along with the increase of MPA-ACU,and the other 4 patients with MPA-ACU >(30μg·h)/mL had the good efficacy.Conclusion In the treatment of refractory GPP,CsA has a more rapid onset than MMF,which,however,has fewer side effects.Therefore,MMF may be used as an alternative in those patients with intolerance to CsA.And MPA-ACU may be able to respond to the curative effect.