英夫利西单抗治疗重度斑块状银屑病的临床疗效及其对PD-1和PD-L1表达水平的影响

Effect of infliximab on expression levels of PD-1 and PD-L1 in severe plaque psoriasis

目的研究英夫利西单抗(IFX)治疗重度斑块状银屑病的临床疗效及其对程序性死亡蛋白1(PD-1)、程序性死亡蛋白配体1(PD-L1)表达水平的影响。方法采用回顾性分析方法,以2019年1月至2022年1月入青岛市中医医院治疗的100例重度斑块状银屑病患者为观察对象,按照治疗方式不同分为研究组(50例)与对照组(50例)。研究组行常规疗法联合IFX治疗,对照组仅行常规疗法治疗。比较两组治疗前后血清PD-1、PD-L1、白细胞介素-18(IL-18)、高迁移率族蛋白B1(HMGB1)、银屑病面积和严重程度指数(PASI)评分、皮肤病生活质量量表(DQLI)评分、治疗后症状(红斑、浸润、皮损面积、鳞屑、瘙痒)改善时间及临床治疗疗效。结果治疗前,两组患者血清PD-1、PD-L1、IL-18、HMGB1水平与PASI评分、DQLI评分比较,差异均无统计学意义(P>0.05);治疗后,两组患者的血清PD-1、PD-L1、IL-18、HMGB1水平与PASI评分、DQLI评分较治疗前显著降低,差异均有统计学意义(P<0.05);研究组血清PD-1、PD-L1、IL-18、HMGB1水平与PASI评分、DQLI评分为(217.67±16.25)ng/L、(282.58±23.49)ng/L、(25.76±5.53)ng/L、(7.48±2.32)ng/mL、(8.73±1.92)分、(5.11±1.42)分,均显著低于对照组[(244.09±19.45)ng/L、(305.69±26.85)ng/L、(31.97±8.47)ng/L、(11.54±2.79)ng/mL、(13.03±2.25)分、(8.76±2.11)分],差异均有统计学意义(P<0.05)。研究组症状改善时间显著短于对照组,差异均有统计学意义(P<0.05)。研究组总有效率为98.00%,显著高于对照组(84.00%),差异有统计学意义(P<0.05)。结论IFX治疗重度斑块状银屑病临床疗效显著,可进一步降低患者血清PD-1、PD-L1、IL-18、HMGB1水平,还可改善皮损面积及严重程度,促进症状消退与生活质量的提高。

Objective To investigate the effect of infliximab(IFX) in the treatment of severe plaque psoriasis and its effect on the expression levels of programmed death protein 1(PD-1) and programmed death protein ligand 1(PD-L1).Methods A retrospective analysis was performed on 100 patients with severe plaque psoriasis who were admitted to Qingdao Traditional Chinese Medicine Hospital from January 2019 to January 2022. According to treatment methods, they were divided into study group(n=50) and control group(n=50). The study group received conventional therapy combined with IFX, and the control group received conventional therapy only. Serum PD-1, PD-L1, interleukin-18(IL-18), high mobility group protein B1(HMGB1), psoriatic area and severity index(PASI) score, skin quality of life scale(DQLI) score and improvement time of symptoms(erythema, infiltration, skin area, scale and pruritus) were compared between the two groups before and after treatment total efficiency.Results Before treatment, there were no significant differences in serum PD-1, PD-L1, IL-18, HMGB1, PASI score and DQLI score between 2 groups(P>0.05). Compared with before treatment, the levels of serum PD-1, PD-L1, IL-18 and HMGB1, PASI score and DQLI score were lower in 2 groups after treatment, and the differences were statistically significant(P<0.05). After treatment, the levels of serum PD-1, PD-L1, IL-18, HMGB1, PASI score and DQLI score were(217.67±16.25) ng/L,(282.58±23.49) ng/L,(25.76±5.53) ng/L,(7.48±2.32) ng/mL,(8.73±1.92) points,(5.11±1.42) points, which were significantly lower than those in the control group [(244.09±19.45) ng/L,(305.69±26.85) ng/L,( 31.97±8.47) ng/L,(11.54±2.79) ng/mL,(13.03±2.25) points,(8.76±2.11) points], and the differences were statistically significant(P<0.05). The symptom improvement time was shorter, and the differences were statistically significant(P<0.05). The total effective rate of the study group was 98.00%, which was significantly higher than that of the control group(84.00%), and the difference was statistically significant(P<0.05).Conclusion IFX has significant efficacy in the treatment of severe plaque psoriasis, which can further reduce the levels of serum PD-1, PD-L1, IL-18 and HMGB1, improve the area and severity of skin lesions, promote symptom resolution and improve quality of life.