[1]顾洋,王召阳,向欣,等.甲氨蝶呤治疗儿童重度斑块型银屑病的疗效及对炎症因子的影响[J].中国皮肤性病学杂志,2019,(08):890-894.[doi:10.13735/j.cjdv.1001-7089.201807128]
 GU Yang,WANG Zhaoyang,XIANG Xin,et al.Methotrexate in the Treatment of Pediatric Severe Plaque Psoriasis and its Effect on Serum Levels of Inflammatory Cytokines in Patients[J].The Chinese Journal of Dermatovenereology,2019,(08):890-894.[doi:10.13735/j.cjdv.1001-7089.201807128]
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甲氨蝶呤治疗儿童重度斑块型银屑病的疗效及对炎症因子的影响
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《中国皮肤性病学杂志》[ISSN:1001-7089/CN:61-1197/R]

卷:
期数:
2019年08期
页码:
890-894
栏目:
论著
出版日期:
2019-07-15

文章信息/Info

Title:
Methotrexate in the Treatment of Pediatric Severe Plaque Psoriasis and its Effect on Serum Levels of Inflammatory Cytokines in Patients
文章编号:
1001-7089(2019)08-0890-05
作者:
顾洋王召阳向欣徐子刚
首都医科大学附属北京儿童医院,北京 100045
Author(s):
GU YangWANG ZhaoyangXIANG XinXU Zigang
(Department of Dermatology and Venereology,Beijing Children's Hospital,Beijing 100045,China)
关键词:
甲氨蝶呤 儿童重度斑块型银屑病 IL-17A IL-23 TNF-α
Keywords:
Methotrexate Pediatric severe plaque psoriasis IL-17A IL-23 TNF-α
分类号:
R 758.63
DOI:
10.13735/j.cjdv.1001-7089.201807128
文献标志码:
A
摘要:
目的 探讨甲氨蝶呤(MTX)治疗儿童重度斑块型银屑病的疗效及对血清中炎症因子IL-17A、IL-23、TNF-α的影响。 方法 18例儿童重度斑块型银屑病患者口服MTX每周0.1~0.3 mg/kg,治疗4~24周,以银屑病受累面积和严重程度(PASI)评分和儿童皮肤病生活质量指数(CDLQI)评分评价疗效; 采用液相悬浮芯片法测定基线和治疗24周后患者血清中IL-17A、IL-23和TNF-α的水平。 结果 18例儿童重度斑块型银屑病患者治疗4、8、12、24周后PASI评分较治疗前显著下降(P均<0.05); 治疗4、8、12、24周后达到PASI75的患者比例分别为11.76%、40.00%、76.92%、100%。治疗12、24周后CDLQI的中位值较治疗前显著下降。9例患者治疗24周后血清中IL-17A、IL-23和TNF-α的水平较治疗前降低(P均<0.05)。不良反应有恶心、食欲减退、谷丙转氨酶及谷草转氨酶轻度升高。 结论 在医师严密的监测下,小剂量的MTX治疗儿童重度斑块型银屑病疗效良好,安全性较高,患者满意度高。随着疗效的提高,患者血清中炎症因子的水平逐渐降低。
Abstract:
Objective The study aims to evaluate the effectiveness of methotrexate(MTX)in the treatment of severe plaque psoriasis in children and to measure the serum levels of IL-17A,IL-23 and TNF-α in patients.Methods Eighteen pediatric severe plaque psoriasis patients were enrolled in this study.A single dose of 0.1~0.3 mg/kg MTX was prescribed once weekly for 4~24 weeks.The efficacy of MTX was evaluated by the psoriasis area-and-severity index(PASI)and children's dermatology life quality index(CDLQI).The baseline and the serum levels of IL-17A,IL-23,TNF-α after 24 weeks of MTX therapy were detected by liquid phase suspension chip.Results PASI score in MTX-treated patients significantly decreased at 4,8,12,24 weeks compared to baseline values(P<0.05).PASI75 at week 4,8,12,24,was achieved in 11.76%,40.00%,76.92%,100% patients,respectively.Median CDLQI decreased significantly at 12 and 24 weeks.After 24 weeks of MTX treatment,the serum concentrations of IL-17A,IL-23,TNF-α were lower than at baseline(P<0.05).The adverse events included nausea,loss of appetite,mildly elevated alanine aminotransferase and aspartate transaminase.Conclusion A low dose of MTX is effective and safe for severe pediatric plaque psoriasis under expert supervision.The reduction in serum concentrations of IL-17A,IL-23,TNF-α after MTX treatment indicates MTX therapeutic efficacy.

参考文献/References:

[1] Holme SA,Man I,Sharpe JL,et al.The children's dermatology life quality index:validation of the cartoon version [J].Br J Dermatol,2003,148(2):285-290.
[2] 中华医学会皮肤性病分会银屑病学组.中国银屑病治疗专家共识(2014版)[J].中华皮肤科杂志,2014,47(3):213-215.
[3] Kalb RE,Strober B,Weinstein G,et al.Methotrexate and psoriasis:2009 national psoriasis foundation consensus conference [J].J Am Acad Dermatol,2009,60(5):824-837.
[4] Hashkes PJ,Becker ML,Cabral David A,et al.Methotrexate:new uses for an old drug [J].J Pediatr,2013,164(2):231-236.
[5] Michelle EA,Elke MGJ,Kerkhof Peter CM,et al.Efficacy and safety of treatments for childhood psoriasis:a systematic literature review [J].J Am Acad Dermatol,2010,62(6):1013-1030.
[6] Kaur I,Dogra S,Dipankar D,et al.Systemic methotrexate treatment in childhood psoriasis:further experience in 24 children from India [J].Pediatr Dermatol,2008,25(2):184-188.
[7] Geel MJ,Oostveen AM,Hoppenreijs EPAH,et al.Methotrexate in pediatric plaque-type psoriasis:long-term daily clinical practice results from the child-capture registry [J].J Dermatolog Treat,2015,26(5):406-412.
[8] Collin B,Vani A,Ogboli M,et al.Methotrexate treatment in 13 children with severe plaque psoriasis [J].Clin Exp Dermatol,2009,34(3):295-298.
[9] Kumar B,Dhar S,Handa S,et al.Methotrexate in childhood psoriasis [J].Pediatr Dermatol,1994,11(3):271-273.
[10] Daniel M,Klufas BS,Jenna M,et al.Treatment of moderate to severe pediatric psoriasis:a retrospective case series [J].Pediatr Dermatol,2016,33(2):142-149.
[11] Dogra S,Handa S,Kanwar AJ.Methotrexat in severe childhood psoriasis [J].Pediatr Dermatol,2004,21(3):283-284.
[12] 舒丹,晋红中.儿童银屑病的治疗[J].中华皮肤科杂志,2013,46(3):210-212.
[13] 黄丹,顾恒,陈崑.儿童银屑病的治疗现状[J].国际皮肤性病学杂志,2010,36(6):309-312.
[14] Park SB,Suh DH.A pilot study to assess the safety and efficacy of topical calcipotriol treatment in childhood psoriasis [J].Pediatr Dermatol,1999,16(4):321-325.
[15] 闫桢桢,吴信峰,陈敏,等.甲氨蝶呤治疗银屑病的临床应用[J].中华皮肤科杂志,2011,44(6):457-460.
[16] 张锡宝,彭振辉,曹振平.MTX对正常人表皮角质形成细胞体外培养增殖的作用及影响[J].中国皮肤性病学杂志,2003,17(6):371-373.
[17] Lynde CW,Poulin Y,Ronald V,et al.Interleukin 17A:toward a new understanding of psoriasis pathogenesis[J].J Am Acad Dermatol,2014,71(1):141-150.
[18] Cesare A,Meglio P,Nestle Frank O,et al.The IL-23/Th17 axis in the immunopathogenesis of psoriasis [J].J Invest Dermatol,2009,129(6):1339-1350.
[19] Takahashi H,Tsuji H,Hashimoto Y,et al.Serum cytokines and growth factor levels in Japanese patients with psoriasis[J].Clin Exp Dermatol,2010,35(6):645-649.
[20] Elghandour TM,Aly DG,Elhameed S,et al.Effect of narrow band ultraviolet b therapy versus methotrexate on serum levels of interleukin-17 and interleukin-23 in Egyptian patients with severe psoriasis[J].Dermatol Res Pract,2013,2013:618269.

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备注/Memo

备注/Memo:
[基金项目] 北京市科委“首都临床特色应用研究”专项课题(Z161100000516070); 北京市自然科学基金资助项目(7174300); 北京市医院管理局临床医学发展专项(ZYLX 201601); 北京市医院管理局儿科学科协同发展中心专项经费资助(XTZD20180502)
[作者单位] 首都医科大学附属北京儿童医院,北京 100045
[通讯作者] 徐子刚,E-mail:xuzigang@bch.com.cn
[Corresponding author] XU Zigang,E-mail:xuzigang@bch.com.cn
更新日期/Last Update: 2019-07-15