单用泼尼松及联用吗替麦考酚酯、硫唑嘌呤治疗天疱疮近期临床观察

发布时间：2019-02-13 15:48

【摘要】：目的:观察泼尼松(P)联合吗替麦考酚酯(MMF)、泼尼松联合硫唑嘌呤(AZA)及单纯使用泼尼松治疗天疱疮的近期疗效及安全性。方法:采用随机对照方法进行观察。选择首次就诊经皮肤活检行组织病理及直接免疫荧光确诊的天疱疮患者42例,随机分为泼尼松联合MMF治疗组(P+MMF组,n=14),单纯使用泼尼松治疗组(P组,n=14)和泼尼松联合AZA治疗组(P+AZA组,n=14),均接受基础(对症支持预防等)治疗。观察治疗前及治疗6个月后皮损变化情况[病情严重程度评分、ABSIS(autoimmune bnullous skin disorder intensity score)评分]、药物使用情况(泼尼松使用剂量及减量情况)、起效时间(第一次泼尼松减量时间、皮损全部消退时间)、有效率、复发率以及不良反应等,对比分析3组的疗效及安全性。结果:3组完成随访观察病例数分别为14(P+MMF组)、13(P组)、14(P+AZA组)例;3组及3组间泼尼松初始量、减少量差异无统计学意义(P0.05);3组泼尼松控制量差异无统计学意义(P0.05),但P+MMF组和P组、P+MMF组和P+AZA组间差异有统计学意义(P0.05);3组观察结束时泼尼松剂量、泼尼松累积总剂量差异有统计学意义(P0.05),但P组和P+AZA组间差异无统计学意义(P0.05)。3组及3组间皮损全部消退时间差异无统计学意义(P0.05)。3组首次泼尼松减量时间、泼尼松减至2/3最大控制量的时间经方差分析显示差异无统计学意义(P0.05),但P+MMF组和P组间首次泼尼松减量时间、泼尼松减至2/3最大控制量的时间差异有统计学意义(P0.05)。3组及3组间有效率、复发率、不良反应差异无统计学意义(P0.05)。结论:3种疗法治疗天疱疮近期疗效和安全性相似,但泼尼松联合MMF组比单纯使用泼尼松组和泼尼松联合AZA组需要更小的泼尼松控制量,还可加快泼尼松减量,减少泼尼松累积使用量。
[Abstract]:Objective: to observe the efficacy and safety of prednisone (P) combined with (MMF), prednisone combined with azathioprine (AZA) and prednisone alone in the treatment of pemphigus. Methods: random control method was used to observe. 42 cases of pemphigus diagnosed by histopathology and direct immunofluorescence were randomly divided into prednisone combined with MMF treatment group (P MMF group, n = 14) and prednisone treatment group (P group). Both prednisone and prednisone combined with AZA treatment group (P AZA group, nng14) received basic (symptomatic support, prevention, etc.) treatment. The changes of skin lesions [severity score, ABSIS (autoimmune bnullous skin disorder intensity score) score] and drug use (prednisone dosage and reduction) were observed before and 6 months after treatment. The effective time (the first time of prednisone reduction, the time of all skin lesion receding), the effective rate, the recurrence rate and the adverse reaction were compared and analyzed. Results: the number of cases in 3 groups were 14 (P MMF group, 13 cases (P group) and 14 (P AZA group respectively, and there was no significant difference in initial dose and reduction of prednisone between 3 groups and 3 groups (P0.05). There was no significant difference in prednisone control volume among three groups (P0.05), but there was significant difference between P MMF group, P MMF group and P AZA group (P0.05). There were significant differences in prednisone dose and total prednisone cumulative dose between the three groups at the end of observation (P0.05). However, there was no significant difference between P group and P AZA group (P0.05). There was no significant difference in the time of all skin lesion regression between group 3 and group 3 (P0.05). The first time of prednisone reduction in group 3 was not significantly different from that in group P (P0.05). The time of reducing prednisone to the maximum control of 2 / 3 had no significant difference by ANOVA (P0.05), but the first time of prednisone reduction between P MMF group and P group was not significant (P0.05). The time difference of prednisone to 2 / 3 maximum control was statistically significant (P0.05). There was no significant difference in effective rate, recurrence rate and adverse reaction between the three groups (P0.05). Conclusion: the short-term efficacy and safety of the three therapies in the treatment of pemphigus are similar, but prednisone combined with MMF can accelerate the reduction of prednisone compared with prednisone and prednisone combined with AZA. Reduce the cumulative use of prednisone.
【作者单位】：四川大学华西医院皮肤性病科;
【分类号】：R758.66

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