异维A酸对中重度痤疮患者远期疗效及糖脂代谢的影响

Effect of Isotretinoin on Long-Term Clinical Efficacy and Glycolipid Metabolism in Patients with Moderate to Severe Acne.

目的分析中重度痤疮患者口服异维A酸后对糖、脂代谢水平的影响以及对远期临床疗效的评估。方法2019年10月至2020年6月招募20例健康志愿者(健康对照组)及61例中重度痤疮患者(试验组)。试验组患者口服异维A酸,治疗开始3、6个月后随访。检测并比较患者治疗前后的血脂水平、空腹血糖、空腹胰岛素和胰岛素抵抗稳态模型评估。结果试验组及健康对照组基线资料相比,试验组患者基线丙氨酸氨基转氨酶、空腹胰岛素水平较健康对照组明显降低(P<0.05),但均处于正常值范围内。试验组患者空腹血糖治疗前后无明显变化,差异无统计学意义(P>0.05),治疗后空腹胰岛素、胰岛素抵抗稳态模型评估值明显高于治疗前,差异有统计学意义(P<0.05);胆固醇、甘油三酯、低密度脂蛋白水平明显高于治疗前,高密度脂蛋白水平明显低于治疗前,差异有统计学意义(P<0.05);所有患者停药后随访半年至1年无复发。结论异维A酸治疗中重度寻常痤疮患者远期治疗效果好,但会增加胰岛素抵抗、降低胰岛素敏感性从而影响糖代谢,对脂代谢的影响还需长期随访观察。

Objective To analyze the effects of isotretinoin on glycolipid metabolism in patients with moderate to severe acne and to evaluate the long-term clinical efficacy.Methods From October 2019 to June 2020,61 patients diagnosed with moderate to severe acne vulgaris(experimental group)and 20 healthy volunteers(healthy control group)were enrolled in this study.Experimental group was treated with isotretinoin and followed up 3 and 6 months after treatment.Blood-lipid level,fasting glucose,fasting insulin,and homeostasis model of assessment-insulin resistance(HOMA-IR)were measured and compared before and after treatment.Results Compared with the baseline data of the experimental group and the healthy control group,the alanine aminotransferase(ALT)and fasting insulin levels of the experimental group were significantly lower than those of the healthy control group(P<0.05),but they were all within the normal range.There were no significant changes of fasting blood glucose in the experimental group before and after treatment,and the differences were not statistically significant(P>0.05);the values of fasting insulin and HOMA-IR after treatment were significantly lower than that before treatment,and the differences were statistically significant(P<0.05).The levels of cholesterol,triglyceride and low-density lipoprotein(LDL)after treatment were significantly higher than those before treatment,while high density lipoprotein(HDL)were significantly lower than those observed before treatment,and the differences were statistically significant(P<0.05).All patients were followed up for 6 months to 1 year after drug withdrawal without recurrence.Conclusion Isotretinoin in the treatment of moderate to severe acne vulgaris has a good long-term treatment effect,but it can increase insulin resistance and reduce insulin sensitivity to affect glucose metabolism.At the same time,the effect on lipid metabolism by isotretinoin also needs long-term follow-up observation.