甲氨蝶呤和卡泊三醇软膏对银屑病患者脂联素和瘦素水平的影响  

Effects of Methotrexate and Calcipotriol Ointment on Adiponectin and Leptin Levels in Patients with Psoriasis

作　　者：阳芳[1,2] 粟娟[3] 高辉 鲁巧云[5] 郑利雄[1,2] 房思宁[1,2] 

机构地区：[1]暨南大学第二临床医学院 [2]深圳市人民医院皮肤科,广东深圳518020 [3]中南大学湘雅医院皮肤科,湖南长沙410008 [4]暨南大学第二临床医学院深圳市人民医院风湿免疫科,广东深圳518020 [5]襄阳市中心医院皮肤科,湖北襄阳441021

出　　处：《中国医院用药评价与分析》2015年第6期705-708,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：深圳市卫生计生系统科研项目(No.201402001)

摘　　要：目的:探讨银屑病患者中脂联素和瘦素水平的改变,以及甲氨蝶呤系统治疗和卡泊三醇外用治疗对脂联素和瘦素水平的影响。方法:将40例寻常型银屑病患者和40例经过年龄和性别匹配的健康志愿者(健康对照组)纳入研究。银屑病严重性评级指标采用银屑病皮损面积和严重程度指数评分。银屑病面积与严重性指数(psoriasis area and severity index,PASI)≤10分的患者,给予卡泊三醇软膏和液态凡士林外用治疗;PASI>10分或合并关节炎的患者,每周口服7.5 mg甲氨蝶呤治疗,并根据临床反应,4周后逐级递增至每周10 mg,8周后逐渐增加至每周15 mg。所有患者同时给予2.5 mg/d叶酸和凡士林外用治疗。对所有银屑病患者治疗前、治疗12周后及对照组人群的血浆脂联素和瘦素水平进行随访检测。结果:银屑病患者脂联素水平较对照组明显降低,瘦素水平明显高于正常对照组,差异有统计学意义(P<0.05)。经过12周的甲氨蝶呤和卡泊三醇软膏治疗,银屑病患者的脂联素水平较治疗前明显升高,瘦素水平较治疗前显著降低,差异有统计学意义(P<0.05)。结论:脂肪因子与银屑病的发病密切相关,使用甲氨蝶呤和卡泊三醇软膏治疗银屑病,可能降低代谢综合征的发生率。OBJECTIVE：To explore the changes in levels of adiponectin and leptin in patients with psoriasis, and study the effects of methotrexate and calcipotriol for external use on adiponectin and leptin levels.METHODS： 40 patients with psoriasis vulgaris and another 40 age-and gender-matched healthy volunteers （ healthy control group） were included in the study.Psoriasis area and severity index score were applied as indexes in psoriasis severity rating.The patients with psoriasis area and severity index （ PASI ） ≤10 points were treated with calcipotriol ointment and liquid vaseline for external use, and those with PASI〉10 points or with associated arthritis were administered orally with methotrexate at initial weekly dose of 7.5 mg with weekly dose increased gradually to 10 mg after 4 weeks based on clinical response and then 15 mg after 8 weeks.Moreover, all the patients were given additional concurrent folic acid （2.5 mg/d） and vaseline for external use.Plasma levels of adiponectin and leptin before treatment and after 12 weeks of treatment in all the psoriasis patients and the normal control group were detected.RESULTS： Plasma level of adiponectin was significantly reduced while plasma leptin level was significantly increased in patients with psoriasis as compared with the normal control group, and the differences between the two groups were statistically significant （ P〈0.05）.After 12 weeks of treatment with methotrexate and calcipotriol ointment, the level of adiponectin increased while the level of leptin decreased significantly in the patients with psoriasis, and the differences were statistically significant （ P〈0.05） .CONCLUSIONS：Adipokines is closely associated with the development of psoriasis; the use of methotrexate and calcipotriol ointment in patients with psoriasis can reduce the incidence of metabolic syndrome.

关 键 词：脂联素 瘦素 银屑病 甲氨蝶呤 卡泊三醇 

分 类 号：R977.1[医药卫生—药品]