米诺环素单药或联合小剂量糖皮质激素治疗红斑型天疱疮15例和疱疹样天疱疮9例疗效和安全性回顾分析  

Retrospective analysis of efficacy and safety of minocycline alone or in combination with low-dose glucocorticoids in the treatment of 15 cases of pemphigus erythematosus and 9 cases of pemphigus herpetiformis

作　　者：樊碧娆 陈喜雪[1] 王明悦[1] Fan Birao;Chen Xixue;Wang Mingyue(Department of Dermatology and Venereology,Peking University First Hospital,National Clinical Research Center for Skin and Immune Diseases,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses,Beijing 100034,China)

机构地区：[1]北京大学第一医院皮肤性病科,国家皮肤与免疫疾病临床医学研究中心,北京市皮肤病分子诊断重点实验室,北京100034

出　　处：《中华皮肤科杂志》2022年第8期676-681,共6页Chinese Journal of Dermatology

摘　　要：目的探讨米诺环素单药或联合小剂量糖皮质激素(简称激素)治疗红斑型天疱疮(PE)和疱疹样天疱疮(PH)的疗效和安全性及对免疫指标的影响。方法回顾性纳入2011年6月至2021年6月于北京大学第一医院皮肤科初诊、初治方案为米诺环素单独或联合小剂量激素且随访至少6个月的PE和PH患者。收集基线及不同随访时间点患者病情、自身抗体水平变化,分析疾病严重程度、诊断、自身抗体变化趋势及与疗效间的关系。采用Kaplan-Meier方法分析完全缓解情况,用卡方检验分析不同严重度和疗法下PF患者的疗效。结果共纳入24例汉族患者,包括15例PE和9例PH,男女比例为1.4∶1,中位年龄68.8岁,中位病程为22.1个月,平均随访时间为21.8个月。24例均获得疾病控制,疾病控制时间M(Q1,Q3)为15.9(12,20.1)周。完全缓解23例(95.8%),完全缓解时间8.7(6.4,10)个月。米诺环素单药治疗1年完全缓解率(11/13)与联合小剂量激素疗法(9/11)差异无统计学意义(χ^(2)=0.16,P=0.692)。随访期间复发2例(8.7%),皆处于疾病控制状态,1例调整剂量后于第38周达完全缓解,另1例换用利妥昔单抗,半年后达到完全缓解。轻中度患者间疗效差异无统计学意义(χ^(2)=0.28,P=0.599)。3例发生药物相关不良反应,1例为背部体癣,2例为全身皮肤及牙龈部位色素沉着。结论米诺环素单药或联合小剂量激素治疗轻中度PE或PH疗效显著,且无严重药物相关不良反应,但该方案的长期疗效、不良反应及患者预后需未来进一步扩大样本量,进行多中心、前瞻性研究。Objective To investigate the efficacy and safety of minocycline alone or in combination with low-dose glucocorticoids in the treatment of pemphigus erythematosus and pemphigus herpetiformis,as well as their effect on immune indices.Methods A retrospective study was conducted,and patients with newly diagnosed pemphigus erythematosus or pemphigus herpetiformis,who received initial treatment with minocycline alone or in combination with low-dose glucocorticoids and were followed up for more than 6 months,were collected from Department of Dermatology,Peking University First Hospital from June 2011 to June 2021.Data on patients′condition and autoantibody levels were collected at baseline and different follow-up time points,and disease severity,diagnosis,changes in autoantibody levels and their relationships with efficacy were analyzed.The Kaplan-Meier method was used to analyze complete remission rate,and chi-square test to analyze the efficacy among patients with different disease severity or after different treatments.Results A total of 24 patients of Han nationality were collected and followed up for a median period of 21.8 months,including 15 with pemphigus erythematosus and 9 with pemphigus herpetiformis.The male to female ratio was 1.4∶1,their median age was 68.8 years,and the median duration of disease was 22.1 months.All the 24 patients achieved disease control,and the time to disease control(M[Q1,Q3])was 15.9(12,20.1)weeks.Twenty-three(95.8%)patients achieved complete remission,and the time to complete remission was 8.7(6.4,10)months.After 1-year treatment,no significant difference in the complete remission rate was observed between patients receiving minocycline monotherapy(11/13)and those receiving combination therapy with low-dose glucocorticoids(9/11,χ^(2)=0.16,P=0.692).During the follow-up period,2 patients(8.7%)experienced recurrence in disease control state,1 of whom achieved complete remission at week 38 after dose adjustment,and the other achieved complete remission after half-a-year treatment w

关 键 词：天疱疮 治疗 米诺环素 糖皮质激素类 嗜酸细胞 中性白细胞 

分 类 号：R758.66[医药卫生—皮肤病学与性病学]