阿达木单抗治疗中重度银屑病疗效观察及吸烟对疗效的影响

Effect of adalimumab in the treatment of moderate and severe psoriasis and the influence of smoking on the effect

目的 观察阿达木单抗治疗中重度银屑病的疗效、吸烟对阿达木单抗治疗银屑病疗效的影响及吸烟是否可预测阿达木单抗治疗银屑病的反应。方法 纳入接受阿达木单抗治疗第一个周期的中重度银屑病患者74例(当前吸烟者17例,非吸烟者57例),填写调查问卷,每4周进行1次随访,分别行PASI评分。结果 (1)当前吸烟患者PASI评分15.4(13.4,26.0)显著高于非吸烟患者11.8(7.2,17.1),差异有统计学意义。(2)应用阿达木单抗治疗4周、8周、12周,随着用药时间及次数的增加,皮损严重程度改善PASI50、PASI75的患者数量逐渐增加。以PASI50、PASI75结果为因变量的Logistic回归分析显示,P=0.039<0.05(OR=4.333)、P=0.045<0.05(OR=3.15),模型成立,当前吸烟对PASI50、PASI75有负面影响。(3)当前吸烟的银屑病患者有效率为64.7%,非吸烟患者有效率为84.2%,非吸烟患者疗效明显优于吸烟患者,差异有统计学意义(P=0.042<0.05)。结论 (1)吸烟患者银屑病严重程度更高。(2)阿达木单抗治疗中重度银屑病疗效显著。(3)阿达木单抗治疗中重度银屑病,吸烟组与非吸烟组疗效存在明显差异,吸烟与疗效呈负相关。

Objective To investigate the efficacy of adalimumab in the treatment of moderate and severe psoriasis and the influence of smoking on the efficacy of adalimumab in the treatment of psoriasis,and whether smoking can predict the response of adalimumab in the treatment of psoriasis.Methods Seventy-four patients with moderate to severe psoriasis(current smokers=17,non-smokers=57)who received adalimumab in the first cycle of treatment.PASI scores were performed by filling in questionnaires and followed up every 4 weeks.Results The PASI score of current smoking patients was 15.4(13.4,26.0)significantly higher than that of non-smoking patients 11.8(7.2,17.1),and the difference was statistically significant.②The number of patients with PASI50 and PASI75 with the increase of the number of times of adalimumab treatment for 4,8,and 12 weeks gradually increased.The results of PASI50 and PASI75 were used as dependent variable Logistic regression analysis,P=0.039<0.05(0R=4.333),P=0.045<0.05(0R=3.15),the model was established,and current smoking had a negative impact on PASI50 and PASI75.The effective rate was 64.7%in smoking patients and 84.2%in non-smoking patients.The effect of non-smoking patients was significantly better than that of smoking patients(P=0.042<0.05),and the difference was statistically significant.Conclusions①The severity of psoriasis in smoking patients is higher.②Adalimumab is effective in the treatment of moderate and severe psoriasis.③In the treatment of moderate and severe psoriasis with adalimumab,there was a significant difference in the efficacy of smoking and non-smoking groups,and smoking was negatively correlated with the efficacy.