阿维A酸治疗银屑病临床疗效观察及血清α-肿瘤坏死因子的检测

The study on TNF-alpha in the sera and the therapeutic effect on psoriasisbefore and after the treatment with neotigason

目的:观察阿维A酸(新体卡松)治疗前后银屑病患者血清中α-肿瘤坏死因子(TNF-α)水平的变化,初步探讨新体卡松的抗炎及免疫调节机制。方法:采用新体卡松犤0.75mg/(kg·d)犦口服治疗6例严重银屑病,症状缓解后,剂量逐渐减为0.50、0.25mg/(kg·d)服用,维持剂量为10mg/d。治疗前、后分别检测患者血清中TNF-α水平及其生物学活性,并与正常人进行对照。结果:6例患者均达到临床治愈,平均起效时间为(9.83±1.72)d;平均痊愈时间为(105.50±23.08)d;正常人血清TNF-α浓度为(0.55±1.34)pg/mL,生物学活性为(2.22±3.59)%;而银屑病患者治疗前后TNF-α浓度分别为(76.49±42.27)pg/mL、(12.50±7.67)pg/mL,生物学活性分别为(68.82±8.00)%、(20.72±8.94)%;与正常人比较差异均有显著性,未发现严重不良反应。结论:新体卡松治疗严重银屑病患者的效果较好,可能是通过抑制TNF-α的形成而起到抗炎及免疫调节作用。

Objectives: To observe the changes of the level of TNF-alpha in the sera of the patients with psoriasis before and after the treatment with neotigason, and to discuss the anti-inflammatory and immunomodulatory mechanism of the drug. Methods: Six severely illed patients with psoriasis were treated with 0.75 mg/(kg·d) of neotigason at the beginning, then gradually decreased to 0.50 mg/(kg·d) and 0.25 mg/(kg·d) after the symptoms were improved, and the maintenance dose was 10 mg per day. The levels and bioactivity of TNF-alpha in the sera were evaluated before and after the treatment. Also, we compared these data of the patients with those of the normal volunteers. Results: All the 6 patients were clinically cured,the average duration of the patients to respond was (9.83±1.72) days, and the average duration of clinical cure was (105.50±23.08) days. The levels and bioactivity of TNF-alpha in the sera of the normal volunteers were (0.55±1.34)pg/mL and(2.22±3.59)%,respectively.In contrast, the levels and bioactivity of TNF-alpha in the sera of the patients were(76.49±42.27)pg/mL and 68.82±8.00)%, respectively before treatment, and (12.50±7.67)pg/mL and (20.72±8.94)% respectively after treatment. There were significant diferences between the patients and volunteers, and between the patients before and after treatment. No severe side-effects were found in all the 6 patients. Conclusions: The treatment of severe psoriasis with neotigason revealed good therapeutic effect, and neotigason may have anti-inflammatory and immunomodulatory action via the inhibition of TNF-alpha expression.