口腔黏膜寻常型天疱疮的口服糖皮质激素治疗:剂量与疗程

Dosage and course of treatment—treating oral pemphigus vulgaris with systemic glucocorticoid therapy

寻常型天疱疮是一类黏膜-皮肤自身免疫相关的大疱性疾病,糖皮质激素是最经典并且最常用的治疗方法。国内外关于天疱疮的治疗学方面的文献比较多,但文章多关注治疗方法的分类,对初始剂量的确定方法较少提及,关于减量及维持具体方法和相关注意事项方面的论述则更少。目前,关于如何系统应用糖皮质激素来治疗寻常型天疱疮,国外有相关的指南予以指导,分别为日本(2014年)、欧洲(2014年)和英国(2003年)的指南,均为皮肤科专家制定;而国内目前尚无相关指南,临床医生在治疗上更依靠自己的临床经验。本文将从治疗的目标和疗程、糖皮质激素的剂量及减量的具体方法2个方面,来详细阐述如何安全有效地通过口服糖皮质激素治疗寻常型天疱疮,旨在为临床医生使用糖皮质激素治疗寻常型天疱疮提供思路。

Pemphigus vulgaris is a kind of auto-immune mucocutaneous blistering disease, and glucocorticoids are the most classic and common treatment for it. Research on the therapies for pemphigus vulgaris is abundant; however, most studies have focused on the classification of treatments and have failed to evaluate the initial dosage. Moreover, reports on tapering dosages and maintenance therapy are rarer. At present, foreign guidelines on methods for treating pemphigus vulgaris with systemic glucocorticoid therapy have come from dermatological experts from Japan, Europe, and Britain. We have no guideline of our own, and clinicians strongly rely on their experience alone. This paper expounds on safely and effectively using oral glucocorticoids in the treatment of pemphigus vulgaris from the perspectives of dosage and the course of treatment. This paper also attempts to present treating standards via related essays and guidelines and provides management strategies for treating pemphigus vulgaris with glucocorticoids.