糠酸莫米松联合莫匹罗星局部治疗激素抵抗特应性皮炎研究

Study on the treatment of steroid-resistant atopic dermatitis with combination topical mometasone furoate cream and mupirocin ointment

目的:观察糠酸莫米松联合莫匹罗星局部治疗激素抵抗特应性皮炎的作用,并探讨其机制。方法:收集该院2015年1月—2016年12月确诊的82例激素抵抗特应性皮炎患者,将其随机分为2组:糠酸莫米松治疗组(A组)30例和糠酸莫米松+莫匹罗星治疗组(B组)52例。A组予外用糠酸莫米松;B组予外用莫匹罗星,间隔2 h后用糠酸莫米松,均每日2次,疗程2周。采用特应性皮炎评分(SCORAD)评价2组疗效。患者治疗前、后均行靶皮损处细菌培养。结果:(1)治疗7 d和14 d后,A组细菌培养阳性率分别为65.22%和60.00%,B组分别为6.82%和0.00%,2组比较差异均有统计学意义(P<0.05)。(2)治疗7 d后,A组和B组总评分分别为(21.05±8.06)分和(23.00±10.57)分,差异无统计学意义(P>0.05);治疗14 d后,2组总评分分别为(17.60±10.88)分和(14.74±8.22)分,差异有统计学意义(P<0.05)。(3)治疗7 d和14 d后,A组有效率分别为8.70%和25.00%,B组有效率分别为18.18%和62.86%,2组比较差异均有统计学意义(P<0.05)。结论:激素抵抗特应性皮炎培养菌种主要是葡萄球菌,尤其是金黄色葡萄球菌,微生物的定植可能是形成激素抵抗的重要原因。糖皮质激素联合抗生素局部治疗激素抵抗特应性皮炎比单用糖皮质激素疗效更佳。

Objective： To observe the effect of mometasone furoate combined with mupirocin ointment on steroid-resistant atopic dermatitis（AD）, and to explore its mechanisms. Methods： A total of 82 outpatients（males and females, 41 each） with steroid-resistant AD were enrolled at the department of dermatology, the first affiliated hospital of Fujian medical university from January 2015 to December 2016. Subjects were randomly assigned to groups A（30 cases） and B（52 cases）. Group A was treated with mometasone furoate cream alone while group B was treated sequentially with mupiroein ointment and mometasone furoate cream at 2-hour interval, twice daily for 2 weeks. Severity scoring of atopic dermatitis index（SCORAD） was used to assess the efficacy. All patients underwent bacterial cultures of the treated area before and after treatment. Results： ①The positive rates of bacterial cultures after 7-day and 14-day treatments were 65.22% and 60.00%, respectively in the group A, and 6.82% and 0.00%, respectively in the group B（P〈0.05 between groups at both time points）. ②After 7 days of treatments, the AD scores were similar in two groups（21.05±8.06 vs. 23.00±10.57）. After 14 days of treatments, AD scores in groups A and B were 17.60±10.88 and 14.74±8.22, respectively（P〈0.05）.③After 7 days and 14 days of treatments, the effective rates were 8.70% and 25.00%, respectively, in group A, and 18.18% and 62.86%, respectively, in group B（P〈0.05 between two groups at both time points）. Conclusions： Cultured strains from the patients with the steroid-resistant AD are mainly Staphylococci, especially Staphylococcus aureus, suggesting microbial colonization may play an important role in the steroid resistance. Combination of glucocortieoid and antibiotics is more effective than the topical glucocorticoid alone for steroid-resistant AD.