小剂量短疗程泼尼松治疗顽固性复发性阿弗他溃疡的疗效及免疫改变

Effects of Prednisone on Clinical Outcome and Immune Parameters in the Treatment of Refractory Recurrent Aphthous Ulcer

目的:探讨小剂量短疗程泼尼松治疗顽固性复发性阿弗他溃疡(顽固性RAU)的临床疗效及对免疫指标调节的作用。方法:选择37例顽固性RAU的患者,小剂量短疗程口服泼尼松治疗1个月,前20d10mg/d,之后5d减量为7.5mg/d,最后5d减量为5mg/d,治疗前后检查血常规、肝肾功能、外周血体液和细胞相关免疫指标,观察治疗1个月、停药2个月后临床疗效及不良反应,治疗1个月后免疫指标改变。结果:小剂量短疗程口服泼尼松治疗顽固性RAU的治疗1个月后总有效率为100%,停药2个月后总有效率为91.4%,治疗1个月后外周血免疫球蛋白及补体(IgG、IgA、IgM、IgE和C4)水平降低(P<0.05),免疫细胞(B、T淋巴细胞及NK细胞)比例未出现明显差异。结论:采用小剂量短疗程泼尼松治疗顽固性RAU有较好的疗效,可延长溃疡发作间歇期,降低溃疡发作的数目、面积及疼痛程度,未见不良反应的发生。调节体液免疫可能是泼尼松治疗顽固性RAU的途径之一。

Objective：To investigate the effects of low-dose and short-course oral prednisone on clinical outcome and immune parameters adjustment in the treatment of refractory recurrent aphthous ulcer（refractory RAU）.Methods：Thirty-seven cases of patients with refractory RAU were administered with low-dose oral prednisone for one month.Ten mg/d prednisone for 20 days was then reduced to 7.5 mg/d for 5days,and subsequently reduced to 5mg/d for the last 5days.Before and after treatment,blood routine,liver and kidney function,humoral and cellular immunity-related parameters in peripheral blood were tested.The clinical outcome and adverse reactions were evaluated after the treatment and two months later.Immune parameters change was observed after treatment.Results：The total efficiency was 100% after the treatment,and 91.4% at two months after the treatment.The levels of immunoglobulins and complements（IgG,IgA,IgM,IgE and C4）in peripheral blood significantly altered after the treatment（P〈0.05）.The percentages of immune cells（B and T lymphocytes and NK cells）in peripheral blood did not significantly change after the treatment.Conclusion：Low-dose and short-course oral prednisone therapy is effective in the treatment of refractory RAU with on adverse reaction,through prolonging intermission,reducing numbers and sizes of ulcers and decreasing pain index.The adjustment of humoral immunity could be one of the ways to treat refractory RAU.