阿维A治疗儿童泛发性脓疱性银屑病疗效及安全性分析

Efficacy and safety of acitretin A in the treatment of children with generalized pustular psoriasis

目的探讨阿维A治疗儿童泛发性脓疱性银屑病的疗效及安全性。方法选择2011年1月至2015年1月湖南省儿童医院收治的泛发性脓疱性银屑病患儿12例为研究对象。所有患儿均给予阿维A口服,初始剂量为0.4～0.8mg/(kg·d),每日1次,维持该剂量并持续治疗2周后评价患儿治疗效果,若治疗无效,则可根据患儿实际状况增加用药剂量,继续用药;若患儿皮损消失90%以上时,逐渐减少用药剂量,直至停药。根据患儿治疗前后的皮损面积及严重程度指数(PASI)评分进行疗效判定,检测谷丙转氨酶、白蛋白、甘油三酯、Ca^(2+)、K^+,观察不良反应,分析患儿的复发状况。结果治愈11例,显效1例,治疗总有效率为100.0%。患儿治疗后PASI评分为(1.5±1.4)分,显著低于治疗前(7.8±2.1)分,差异有统计学意义(P<0.05)。患儿治疗后谷丙转氨酶、血清白蛋白水平显著高于治疗前,甘油三酯水平显著低于治疗前,差异有统计学意义(P<0.05)。患儿治疗前后血中Ca^(2+)、K^+水平比较差异无统计学意义(P>0.05)。12例患儿中出现瘙痒6例,黏膜干燥2例,血脂轻微异常1例,肝酶升高3例,甲脆性增加3例,所有患儿不良反应症状均较轻,未出现明显肝肾功能异常,且患儿不良反应症状均在实施对症处理(饮食调理、改变用药剂量等)后消失,未影响用药过程。患儿随访1～2年,共5例患儿复发,复发率为41.7%。结论儿童泛发性脓疱性银屑病实施阿维A治疗的疗效及安全性均较高。

Objective To investigate the efficacy and safety of acitretin A in the treatment of children with generalized pustular psoriasis.Methods From January2011to January2015,12children with pustular psoriasis were admitted to Hunan Children's Hospital were enrolled.All children were given acitretin A orally,at the initial dose of0.40.8mg/(kg·d),once daily.The same dose was maintained during the following two weeks of treatment,after which,the treatment effect was evaluated.If it was ineffective,the dose was increased according to the children's condition and the treatment was continued.If the skin lesion of children disappeared more than90%,the dose was gradually reduced until it was stopped.The effect was assessed based on the skin lesion area and PASI scores before and after treatment;the GPT,albumin,triglyceride,of Ca2+and K+were determined;the adverse reactions were observed and the relapse in children were analyzed.Results Eleven cases were cured and the treatment was markedly effective in1case,the total effective rate being100.0%.PASI score was(1.5±1.4)points after treatment,which was significantly lower than that before treatment(7.8±2.1),the difference being statistically significant(P<0.05).After treatment the level of alanine aminotransferase and serum albumin was significantly higher than before treatment,while triglyceride level was significantly lower than before treatment,and the difference was statistically significant(P<0.05).There was no significant difference in the levels of Ca2+and K+of children before and after treatment(P>0.05).There were6cases of pruritus,2cases of mucous membrane dryness,1case of slight dyslipidemia,3cases of elevated liver enzymes,and3cases of embolism increased;the adverse reactions were mild in all the12cases;there was no significantly abnormal liver and kidney function,and the adverse reactions disappeared after symptomatic treatment(diet conditioning,changing the dosage,etc.),which did not affect the medication process.Children were followed up for1to2years,and a total of5cases of children relapsed,the recurrence rate being41.7%.Conclusion Acitretin A has higher efficacy and safety in the treatment of children with generalized pustular psoriasis.