目的：探讨银屑病合并蛋白尿患者的临床特点。方法：回顾性分析1996年1月～2005年8月收治的银屑病合并蛋白尿者临床资料，并与银屑病非蛋白尿者的临床特点比较。结果：银屑病合并不明原因蛋白尿48例，皮肤受累面积与蛋白尿程度无相关关系（P＞0.05），但银屑病合并蛋白尿组的银屑病病程更短,肾脏病理荧光表现为IgA沉积为主。蛋白尿组皮肤受累面积与非蛋白尿组皮肤受累面积比较，无统计学意义（P＞0.05），蛋白尿组和非蛋白尿组的病程也无统计学差异（P＞0.05）。结论：银屑病合并不明原因蛋白尿值得重视，有必要对其发病机制、临床特点、病理特征进行深入的研究。
Objective To assess the efficacy and safety of efalizumab in the treatment of psoriasis. Methods Randomized controlled trials (RCT) on efalizumab in the treatment of psoriasis were identified from The Cochrane Library ( issue 1, 2006) , specialized trials registered in Cochrane Skin Group (2006), MEDLINE (1966 - 2006) and EMBASE (1974 - 2006). The quality of the trials was assessed by two reviewers independently. RevMan 4.2.7 software provided by the Cochrane Collaboration was used for statistical analysis. Results Three RCTs involving 1 651 patients were included, all of which were of high methodological quality. All the patients were diagnosed as chronic moderate to severe plaque psoriasis with the age of 18-75 years. Meta-analysis indicated that at week 12, significantly more patients in both 1mg/kg/w and 2 mg/kg/w efalizumab subcutaneous groups achieved PASI50, PASI75, PASI90 improvement compared to the placebo group (Plt;0.0001), while there was no significant difference in PASI50, PASI75 and PASI90 responses between 1mg and 2mg efalizumab groups (P gt;0.05). No serious adverse effects were identified. Extended treatment for another 12w may contribute to further efficacy without increasing toxicty. Conclusions Efalizumab 12w therapy is safe and effective for treating adult patients with moderate to severe plaque psoriasis. More RCTs are required to assess the efficacy of the extended treatment.
Objective To analyze whether there is a causal association between psoriasis and Alzheimer disease (AD) by a two-sample two-way Mendelian randomization (MR) method. Methods In the forward study, the single nucleotide polymorphisms (SNPs) associated with psoriasis were obtained from the comprehensive statistical data of the genome-wide association study database as the instrumental variables, and AD as the outcome; in the reverse study, the SNPs associated with AD were taken as instrumental variables, and psoriasis as the outcome. Using two-sample two-way MR analysis, the odds ratio (OR) value and 95% confidence interval (CI) of regression models, namely inverse variance weighted (IVW) method, MR-Egger regression method, weighted median method, simple pattern method, and weighted pattern method, were used to evaluate the causal relationship between psoriasis and AD. Cochran’s Q test was used to assess the heterogeneity of genetic instrumental variables, MR-Egger intercept method was used to test the horizontal pleiotropy of the assessment, “leave-one-out” method was used to assess the sensitivity of a SNP to the effect of causality, and the symmetry of funnel plot was observed to assess bias. Results A total of 19 SNPs associated with psoriasis were included as instrumental variables in the forward study. The IVW analysis of the forward study showed that there was a causal correlation between psoriasis and AD [OR=1.032, 95%CI (1.014, 1.051), P<0.001], and MR-Egger regression method [OR=1.042, 95%CI (1.012, 1.073), P=0.013], weighted median [OR=1.048, 95%CI (1.023, 1.074), P<0.001], and weighted model [OR=1.046, 95%CI (1.020, 1.073), P=0.002] all supported this result. Heterogeneity test (IVW result: Q=13.752, P=0.745; MR-Egger regression result: Q=13.134, P=0.727), MR-Egger intercept method (Egger intercept=–0.004, P=0.442), the results of “leave-one-out” method and funnel plot showed that the results of MR analysis were reliable. A total of 127 AD-related SNPs were included as instrumental variables in the reverse study. In reverse research, there was no evidence to support the AD could increase the risk of psoriasis (P>0.05). Heterogeneity test (IVW result: Q=232.496, P<0.001; MR-Egger regression result: Q=232.119, P<0.001) suggested heterogeneity, but MR-Egger intercept method (Egger intercept=0.003, P=0.652), the results of “leave-one-out” method and funnel plot showed that the results of MR analysis were reliable. Conclusion There is a causal association between psoriasis and AD, and psoriasis may increase the risk of AD.
Objective To assess the relationship between IFN-γ and psoriasis. Methods We searched The Cochrane Library (Issue 3, 2005), MEDLINE (1996 to 2005) and the China Biological Medicine Database (1978 to 2005). The search was conducted in November 2005. The quality of included clinical controlled trials, case studies and cohort studies was evaluated independently by three reviewers. RevMan 4.2.8 software was used. Results In total, 23 studies were included, involving 612 psoriasis patients and 441 healthy controls. All studies did not provide sufficient detail, on the random sampling and the specificity of the kits used for the analyses. Compared with the controls, the serum or plasma IFN-γ in psoriasis patients showed significantly higher levels (SMD=0.89, 95%CI 0.29 to 1.48; and RR=6.20, 95%CI 1.78 to 21.61). The concentration of IFN-γ in supernatant obtained from cultured cells showed slightly higher levels (SMD=0.99, 95%CI -0.01 to 1.99; and RR=5.54, 95%CI 2.03 to 15.13). Conclusion The evidence currently available shows that the increase of IFN-γ may be relevant to psoriasis. However, these results could be affected by the high risk of selection, confounding and detection bias of included studies. More persuasive evidence, from high quality studies, is needed.
目的 通过对白芍总苷治疗前后寻常型银屑病患者血清中白介素（IL）-22水平的研究，探讨其治疗寻常型银屑病的作用机制。 方法 2009年10月－2010年8月采用双抗体夹心酶联免疫吸附法，检测30例寻常型银屑病患者，经白芍总苷治疗前后及健康对照组20例外周血清中IL-22浓度的变化，分析其在治疗前、后与银屑病皮损面积和严重程度指数（PASI）评分的相关性。 结果 寻常型银屑病患者血清IL-22浓度[（90.50 ± 51.80）pg/mL]较对照组[（40.10 ± 17.20）pg/mL]升高，白芍总苷治疗后血清中IL-22水平[（48.70 ± 23.90）pg/mL]较治疗前降低（P＜0.05），并与对照组差异无统计学意义（P＞0.05）；治疗前、后患者血清IL-22水平与PASI评分呈正相关。结论 白芍总苷可能通过调节IL-22发挥治疗寻常型银屑病的作用。
Objective To assess the efficacy and safety of adalimumab on plaque psoriasis. Methods We searched the MEDLINE (1966 to December 2009), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 12, 2009), EMbase (1980 to December 2009), CBM (1978 to December 2009), and CNKI (1979 to December 2009) to collect randomized controlled trials (RCTs) of adalimumab for plaque psoriasis. The language was confined to English and Chinese. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses by using the Cochrane Collaboration’s RevMan 4.2 software. Results Three RCTs involving 1?630 patients with chronic moderate or severe plaque psoriasis were included and assessed. At the end of 4th, 8th, 12th and 16th week, the PASI 75s of subcutaneous injection every other week in adalimumab (EOW) group were obviously higher than that of placebo group and methotrexate group. While at the end of 24th week and 60th week, the PASI 75s showed no difference between adalimumab EOW and placebo group. Twelve weeks after subcutaneous injection each week with adalimumab (QW), PASI 75 was obviously higher than those of placebo and EOW groups. However, at the end of 24th week and 60th week, there was no significant difference between adalimumab QW and placebo followed by adalimumab EOW. At end of week 12-16, there was no difference between adalimumab EOW group and placebo group in the incidence of adverse effects, with the exception of pain on injection site and upper respiration viral infection. At week 12-60, there was no difference between adalimumab QW and EOW groups in the incidence of adverse effects, with the exception of all serious adverse effects. Conclusion The limited evidence indicates that subcutaneous injection of adalimumab every other week for 12-16 weeks is safe and efficient for patients with moderate or severe plaque psoriasis. The efficacy can’t be enhanced when the treatment is prolonged to 24 weeks. The once-a-week protocol has no obvious advantage over every other week protocol. More RCTs are required to verify these conclusions owing to the limitations of the present study.
【摘要】 目的 观察窄谱中波紫外线联合复方甘草酸苷治疗寻常性银屑病的疗效。 方法 2007年2月—2010年11月，将收治的126例银屑病患者随机分为治疗组和对照组，治疗组72例采用注射复方甘草酸苷与窄谱中波紫外线联合治疗，对照组54例则仅采用窄谱中波紫外线治疗，以银屑病皮损面积和疗效指数（PASI）评价对比两组疗效。 结果 两组治疗后PASI评分均明显低于治疗前；治疗后治疗组PASI评分低于对照组，且差异有统计学意义（Plt;0.05）；两组治疗有效率分别为87.5%和79.6%，治疗组疗效明显优于对照组（Plt;0.05）。 结论 窄谱中波紫外线与复方甘草酸苷联合治疗寻常性银屑病，不良反应小，治愈率高，值得临床推广。【Abstract】 Objective To observe the clinical efficacy of compound glycyrrhizin combined with narrow-band ultraviolet B (NB-UVB) in treating patients with psoriasis vulgaris. Methods A total of 126 patients with psoriasis vulgaris treated in our hospital from February 2007 to November 2010 were randomly divided into the treatment group and the control group. Seventy-two patients in the treatment group were treated with NB-UVB radiotherapy combined with compound glycyrrhizin, and 54 patients in the control group were treated with NB-UVB radiotherapy alone. The curative effects were evaluated in terms of the area of injury and therapeutic effect indexes. Results The PASI score after treatment for both groups was obviously lower than before, and the score of the treatment group was significantly lower than the control group after treatment. The efficacy rate was respectively 87.5% and 79.6% for the treatment group and the control group, with a significant difference (Plt;0.05). Conclusion NB-UVB combined with compound glycyrrhizin is safe and effective in treating psoriasis vulgaris, and it is worth popularizing.
目的 为红皮病型银屑病患者制定循证治疗方案。 方法 2012年3月收治1例红皮病型银屑病患者，充分评估患者情况后，提出临床问题，计算机检索Cochrane图书馆、 Medline、中文全文期刊医学数据库中相关研究，根据检索结果结合患者实际情况，制定治疗方案。 结果 共检索到相关文献3篇。通过对检索结果进行分析，并结合患者意愿，为患者制定了采用甲氨喋呤的治疗方案。经过6个月的治疗随访，证实该方案适合该患者。 结论 采用循证医学的方法，为红皮病型银屑病患者制定合理的治疗方案，可提高疗效。