环孢素A和甲氨蝶呤轮替疗法在慢性斑块型银屑病长期系统治疗中的优势

Advantage of cyclosporine A and methotrexate rotational therapy in long-term systemic treatment for chronic plaque psoriasis

目的评估环孢素A和甲氨蝶呤轮替疗法的安全性。分析治疗过程中引起副反应发生的危险因素。方法本试验采用回顾性研究,选定2012年4月至2016年4月于海南省皮肤性病防治中心医院接受环孢素A及甲氨蝶呤轮替治疗的银屑病患者作为研究对象,回顾性收集了这些患者的临床数据及用药情况。所有患者在开始治疗前及随后的随访过程中均完成血常规、肝酶测定、肾功能及尿检等实验室检查。研究过程中,记录在轮替治疗中出现的任何不良事件。结果进行初筛后,共有42例银屑病患者入选。药物的平均用药时间及累积用药剂量为:环孢素A(456.79±472.14)d,(134.68±183.24)g;甲氨蝶呤(274.51±215.32)d,(418.62±435.63)mg。有4例患者在轮替治疗后出现实验室检查异常:4例(9.5%)患者出现转氨酶的异常,其中2例(4.8%)患者还同时伴有尿酸异常。所有患者的肾功能检查(血肌酐及血尿素氮)、血细胞计数及尿检均未出现异常。结论在慢性斑块型银屑病的长期系统治疗中,利用环孢素A和甲氨蝶呤轮替疗法可以很大程度上降低各类药物副作用,特别是肾脏毒性的发生。在轮替疗法治疗过程中,患者流行病学、病程长短、疾病严重程度、用药剂量及时长并不是引起药物副反应的高危因素。

Objective To evaluate the safety of cyclosporine （CsA） and methotrexate （MTX） in the treat- ment of psoriasis and to analyze the risk factors of side effects in the course of treatment. Methods In this retro- spective study, the patients with psoriasis treated with CsA and MTX were enrolled from April 2012 to April 2016 in Hainan Province. The clinical data and medication status of the patients were retrospectively collected. All pa- tients underwent laboratory tests such as blood, liver enzyme, renal function, and urine tests before treatment and during the follow-up. During the course of the study, any adverse events were recorded in the rotation treatment. Results A total of 42 psoriatic patients were enrolled. After screening, 42 patients with psoriasis were enrolled. The average dosage and cumulative dose were （456.79 ± 472.14） days, and （134.68 ± 183.24） g for cyclosporine and （274.51 ± 215.32） days, （418.62 ± 435.63 ）mg for methotrexate. Four patients had abnormal laboratoDT tests after treatment： 4 patients （9.5%） had abnormal transaminases and 2 （4.8%） were accompanied by abnormal uric acid. The renal function tests （serum creatinine and blood urea nitrogen） , blood cell count and urine tests for all patients were in the normal range. Conclusions In the long-term systemic treatment of chronic plaque psoriasis, the use of cyclosporine A and methotrexate therapy can largely reduce the side effects of drugs, especially the oc- currence of renal toxicity. In the course of treatment, the epidemiology of patient, duration of disease, severity of the disease, the dose and duration of drugs are not high risk factors for the side effects of drugs.