抗TNF-α单克隆抗体治疗银屑病及银屑病关节炎临床评价

摘要

Objective: To evaluate the efficacy and safety of infliximab on psoriasis and psoriatic arthritis.Methods: Sixteen patients with psoriasis including 4 psoriatic arthritis patients were enrolled in this study.Infliximab 5 mg/kg was given at week 0,2,6 and 14.Psoriasis area and severity index score (PASI) was used to evaluate the severity of illness.Skin score (PASI standard) , the number of inflammatory joints, C-reactie protein, Erythrocyte sedimentation rate and HAQ score were calculated to evaluate psoriatic arthritis patients.Adverse reactions were observed.Results: At week 18 , 12 patients (100％ ) with psoriasis had obtained more than 90％ PASI improvement, PASI was decreased from 20.6 ± 8.4 to 2.1 ±1.5 after treatment (P ＜ 0.05 ).Skin lesions of 4 cases with psoriatic arthritis also improved obviously and the improvement rate of PASI was 84 ％.Among them, joint inflammation had disappeared in 3 patients while the number of inflammatory joints in another patients reduced from 12 to 2.The levels of CRP and ESR after treatment decreased from (37.8 ±23.8) mg/L to (2.4 ± 1.5) mg/L, and (62.3 ±39.2) mm/h to (8.5 ±5.9) mm/h, respectively.HAQ scores decreased from (1.73 ±0.79) to (0.18 ±0.24).During treatment, adverse events occurred in 4 of 16 patients, two cases of which had upper respiratory tract infection, with one having lymphadenitis colli and one suffering from cervical lymph node tuberculosis.In subsequent treatment, only 1 patient with psoriasis deteriorated showed the worsening of skin lesions, with increased ESR and CRP.Conclusion: Not only can infliximab improve skin lesions of patients with psoriasis, it can also improve the conditions of patients with psoriatic arthritis.Although it is safe for patients with psoriasis, monitoring infection, especially tuberculosis, is also needed.%目的:评价抗TNF-α单克隆抗体英夫利昔单抗治疗银屑病及银屑病关节炎的临床疗效及安全性.方法:2009年5月-2010年5月该院风湿门诊及住院治疗的银屑病患者16例,其中4例合并关节炎.分别于第0、2、6、14周予英夫利昔单抗5 mg/kg治疗,第18周评价疗效及安全性.采用银屑病面积与严重性指数(PASI)评价银屑病病情;采用皮肤评分(PASI标准)、肿胀及压痛关节数、CRP及ESR、健康评定问卷(HAQ)评分评价银屑病关节炎患者病情;记录患者用药后的不良反应.结果:治疗第18 周,12例银屑病患者获得PASI 90%改善(PASI90),PASI由治疗前(20.6±8.4)分降至治疗后(2.1±1.5)分(P﹤0.05).4例合并关节炎的银屑病患者PASI平均改善率为84%,3例患者关节肿痛消失,1例患者肿胀及压痛关节数由治疗前12个减少到2个;治疗后CRP、ESR、HAQ评分均明显下降.治疗过程4例出现不良反应,其中上呼吸道感染2例,颈部皮病性淋巴结炎1例,颈部淋巴结结核1例.随访24～54周,15例患者病情稳定,仅1例患者出现复发.结论:英夫利昔单抗可有效改善银屑病患者皮肤损害,同时对银屑病关节炎也具有较好疗效,安全性较好,未见严重不良事件.