度普利尤单抗治疗特异性皮炎的临床应用研究  

Clinical Application Study on Dupilumab in the Treatment of Atopic Dermatitis

作　　者：丁钰 华圣元 DING Yu;HUA Shengyuan(Department of Dermatology,Mianyang Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Mianyang 621000,Sichuan,China;Department of Dermatology,Children's Hospital of Shanghai,Shanghai 200062,China)

机构地区：[1]电子科技大学医学院附属绵阳医学院绵阳市中心医院皮肤科,四川绵阳621000 [2]上海市儿童医院皮肤科,上海200062

出　　处：《中国美容医学》2022年第8期13-17,共5页Chinese Journal of Aesthetic Medicine

摘　　要：目的:研究度普利尤单抗对特异性皮炎(Atopic dermatitis,AD)患儿皮损程度、湿疹面积及白介素-13(Interleukin-13,IL-13)/白介素4(Interleukin-4,IL-4)轴的影响。方法:采用随机数字表法将医院2018年1月-2020年1月收治的86例特异性皮炎患儿均分为A、B两组,其中A组患者仅接受基础治疗,B组患儿在基础治疗上联合度普利尤单抗治疗。比较两组治疗前后皮损情况、疗效、外周血炎症因子水平、治疗不良反应及生活质量等指标。结果:两组治疗后,特异性皮炎评估(Scoring atopic dermatitis index,SCORAD)评分量表中皮损范围、严重程度、瘙痒与睡眠各分项得分及总得分均较同组治疗前显著下降(P<0.05),且B组经治疗后,患儿SCORAD量表中各分项及总得分均显著低于A组治疗后水平(P<0.05)。治疗后,两组患儿血清IL-13、IL-4水平均较同组治疗前显著下降(P<0.05),干扰素-γ(Interferonγ,IFN-γ)水平显著上升(P<0.05),且B组患儿治疗后血清IL-13、IL-4水平均显著低于A组治疗后水平(P<0.05),IFN-γ显著高于A组治疗后水平(P<0.05)。B组治疗有效率为72.09%,显著高于A组的48.84%(P<0.05)。治疗后,两组生活质量指数(Dermatology life quality index,DLQI)各分项及总得分均显著低于同组治疗前水平(P<0.05),且B组治疗后,患儿DLQI量表中各项及总得分均显著低于A组治疗后水平(P<0.05)。两组治疗期间不良反应无显著性差异(P>0.05)。治疗后随访1年,发现B组治疗后至首次复发时间显著长于A组(P<0.05),治疗后1年内平均复发次数显著低于A组(P<0.05)。治疗1年后,A组患者外周血CD4^(+)水平显著低于B组(P<0.05),CD8^(+)水平显著高于B组(P<0.05),两组CD4^(+)/CD8^(+)无显著性差异(P>0.05)。结论:度普利尤单抗能有效减轻AD患儿皮损严重程度,缩小湿疹面积,度普利尤单抗可能通过阻断IL-13/IL-4轴改善以上症状,且药物治疗效果好,安全性高。Objective To investigate the effect of dupilumab on severity index,eczema area and interleukin-13/interleukin-4(IL-13/IL-4)axis in patients with atopic dermatitis(AD).Methods Eighty-six patients with AD in the hospital from January 2018 to January 2020 were enrolled,and divided into two groups by random number table methods.Group A received routine treatment,while group B received routine treatment combined with dupilumab.The lesions,efficacy,levels of peripheral blood inflammatory factors,treatment adverse reactions and quality of life before and after treatment were compared between the two groups.Results The scores of eczema area,severity index,itching and sleep and total score of scoring atopic dermatitis(SCORAD)were decreased in both groups after treatment(P<0.05),and the decrease was more significant in group B than in group A(P<0.05).A decrease in IL-13 and IL-4 levels and an increase in interferonγ(IFN-γ)level were found in both groups after treatment,and both changes were more obvious in group B than in group A(P<0.05).The clinical efficacy rate was 72.09%in group B,which was significantly higher than 48.84%in group A(P<0.05).After treatment,the score of Dermatology Life Quality Index(DLQI)was decreased in both groups,and was lower in group B than in group A(P<0.05).The adverse reaction rate showed no significant difference between groups(P>0.05).During the 1-year follow-up period,the onset time of first recurrence was later in group B than in group A(P<0.05),and the frequency of recurrence at 1 year after treatment was also lower in group B than in group A(P<0.05).After 1 year of treatment,the peripheral blood CD4^(+)level of group A was significantly lower than that of group B(P<0.05),and the CD8^(+)level was significantly higher than that of group B(P<0.05),while no significant difference was found in CD4^(+)/CD8^(+)between the two groups(P>0.05).Conclusion Application of dupilumab for children with AD can effectively ameliorate the skin damage and diminish the eczema area via blocking IL-13/IL-4 ax

关 键 词：度普利尤单抗 特异性皮炎 皮损程度 湿疹面积 白介素-13 白介素-4 

分 类 号：R758.23[医药卫生—皮肤病学与性病学]