司库奇尤单抗治疗伴潜伏性结核感染和乙型肝炎肝硬化的红皮病型银屑病1例并文献复习  

A case of erythrodermic psoriasis with latent tuberculosis infection and hepatitis B cirrhosis treated with Secukinumab and literature review

作　　者：房黎亚 窦爱华 宫模杰 王宝林[1] FANG Liya;DOU Aihua;GONG Mojie;WANG Baolin(Department of Dermatology,Zaozhuang Municipal Hospital,Shandong Province,Zaozhuang 277100,China)

机构地区：[1]山东省枣庄市立医院皮肤科,山东枣庄277100

出　　处：《中国当代医药》2024年第1期150-154,共5页China Modern Medicine

摘　　要：因生物制剂有选择性免疫抑制作用,银屑病患者长期使用可能导致乙型肝炎病毒、结核分枝杆菌的再激活,临床应用发现,司库奇尤单抗相对其他生物制剂安全性更高。本文回顾性收集1例司库奇尤单抗治疗伴潜伏性结核感染、乙型肝炎肝硬化的红皮病型银屑病患者,因不规律系统使用激素引起双侧股骨头坏死,经知情同意,抗乙肝病毒、预防性抗结核治疗后,给予司库奇尤单抗标准方案治疗,并先后给予双侧“全髋关节置换术”,治疗第24周患者达到银屑病面积和严重程度指数(PASI)90,第40周达到PASI100,治疗第60周患者仍能达到PSAI90,仅双胫前有散在鳞屑性红斑,随访至今未见乙肝病毒再复制、活动性结核发生。本文通过对此病例介绍及复习相关文献,展现了司库奇尤单抗的有效性和安全性,并提高皮肤科医生对生物制剂改善代谢性共病的认知,期望能使更多的银屑病伴发乙肝、结核的患者获得更好的临床预后。Due to the selective immunosuppressive effect of biological agents,long-term use in psoriasis patients may lead to reactivation of hepatitis B virus and mycobacterium tuberculosis.Clinical applications have found that Secukinumab is safer than other biological agents.This article retrospectively collected a case of erythrodermic psoriasis patient with latent tuberculosis infection and hepatitis B cirrhosis treated by Secukinumab,who suffered from bilateral femoral head necrosis due to irregular systematic use of hormones.After informed consent,the patient was given anti-hepatitis B virus and pre-ventive antituberculosis treatment.After that,the patient was given the standard protocol of Secukinumab and then bilateral total hip arthroplasty.At the 24"week of treatment,the patient's psoriasis area and severity index(PASI)reached 90;and at the 40"week,the patient reached PASI100,at the 60"h week of treatment,the patient still reached PSAI90,with only the scaly erythema scattered in front of both tibia.Up to now,no hepatitis B virus replication and active tuberculosis have been found during follow-up.Through the introduction of this case and review of relevant literature,this article shows the effec-tiveness and safety of Secukinumab,and promote dermatologists'awareness of biological agents in improvement of metabolic comorbidity,hoping to make more patients with psoriasis accompanied by hepatitis B and tuberculosis obtain better clinical prognosis.

关 键 词：红皮病型银屑病 潜伏性结核感染 乙型肝炎肝硬化 司库奇尤单抗 抗白介素-17A 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]