白细胞介素-17A抑制剂治疗银屑病诱导免疫漂移风险因素研究  

Study on risk factors for immune shift induced by IL-17A inhibitor in the treatment of psoriasis

作　　者：冯斐 李瑞程 田蕊 谭姝慧 刘明月 聂振华[3] FENG Fei;LI Ruicheng;TIAN Rui;TAN Shuhui;LIU Mingyue;NIE Zhenhua(School of Graduate Studies,Tianjin Medical University,Tianjin 300070,Chian;School of Graduate Studies,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China;Department of Dermatology,Tianjin Academy of Traditional Chinese Medicine Afiliated Hospital,Tianjin 300120,China)

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津中医药大学研究生院,天津301617 [3]天津市中医药研究院附属医院皮肤科,天津300120

出　　处：《临床皮肤科杂志》2025年第4期202-207,共6页Journal of Clinical Dermatology

基　　金：河北省中医药管理局科研计划项目(T2025049)资助项目。

摘　　要：目的:探讨银屑病患者在生物制剂治疗中免疫漂移发生的风险因素,为临床生物制剂的安全使用提供理论依据。方法:回顾性分析白细胞介素(IL)-17A抑制剂治疗160例银屑病患者发生免疫漂移与临床指标之间的相关性,并探究诱发免疫漂移的风险因素。使用基因靶向测序检测30例患者CARD14基因的突变情况,按是否出现矛盾性湿疹将其分为试验A组(20例)和试验B组(10例),并探究遗传因素与免疫漂移发生的关系。结果:是否发生免疫漂移的患者过敏性疾病病史、家族史、嗜酸性粒细胞计数、总蛋白、高密度脂蛋白和总IgE水平比较,差异均具有统计学意义(P<0.05)。单因素Cox回归分析显示,过敏性疾病病史、家族史、嗜酸性粒细胞升高、血清钠升高和总IgE水平升高有统计学意义(HR>1,P<0.05)。多因素Cox比例风险模型显示过敏性疾病病史、家族史、嗜酸性粒细胞升高及总IgE水平升高有统计学意义(HR>1,P<0.05)。本研究结果示试验A组11例(55.00%)患者CARD14基因的rs11652075(C>T)突变阳性,试验B组1例(10%)患者为阳性,差异具有统计学意义(P<0.05)。结论:IL-17A抑制剂治疗的银屑病患者过敏性疾病病史、家族史、嗜酸性粒细胞升高和总IgE水平升高为免疫漂移发生的独立风险因素。同时,存在CARD14基因的错义变异体rs11652075的银屑病患者更容易发生免疫漂移。Objective:To investigate the risk factors for immune shift in patients with psoriasis receiving biologic therapy to provide theoretical basis for the safe use of biologic therapy.Methods:By conducting a retrospective study(160 cases of psori-asis),we statistically analyze the correlation between the occurrence of immune shift during IL-17A inhibitors therapy and clin-ical indicators,aiming to explore the risk factors for immune shift.Targeted gene sequencing is used to detect CARD14 gene mutations in 30 patients with psoriasis,who were divided into the experimental group A(20 cases)and the experimental group B(10 cases)according to the occurrence of paradoxical eczema.Results:There was a statistically significant difference(P<0.05)in thehistory of prior allergic reaction,family history,eosinophil counts,total protein level,highdensity lipoprotein level,and total IgE levels,between patients who experienced immune shift and those who did not.Univariate Cox regression analysis showed that the history of prior allergic reaction,family history,elevated eosinophil count,increased serum sodium level,and elevated total IgE were statistically significant different(HR>1,P<0.05)between patients who experienced immune shift and those who did not.The multivariate Cox proportional hazards model indicated that the history of prior allergic reaction family history,ele-vated eosinophil count,and elevated total IgE were statistically significant(HR>1,P<0.05).The test results showed that 11(55.00%)patients in the experimental group A had the CARD14 gene rs11652075(C>T)mutation,while only 1(10%)patient in the experimental group B was positive,and the difference was statistically significant(P<0.05).Conclusion:In psoriatic pa-tients treated with IL-17A inhibitors,a history of allergic reaction,family history,elevated eosinophil count,and elevated total IgE levels are independent risk factors for the occurrence of immune shift.Additionally,psoriasis patients with the CARD14 gene missense variant rsl1652075 are more likely to experienc

关 键 词：银屑病 白细胞介素-17A 生物制剂 免疫漂移 湿疹 CARD14 IGE 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]