目的 观察阿维A联合喜炎平注射液治疗斑块型银屑病的临床疗效及安全性,对斑块型银屑病患者血清肿瘤坏死因子(TNF)-α的影响.方法 100例斑块型银屑病患者随机分为观察组(阿维A联合喜炎平注射液治疗)和对照组(阿维A治疗)各50例,疗程4周,比较:①2组患者治疗后的总有效率;②2组患者治疗前后银屑病皮损面积和严重度指数(PASI)评分的变化情况;③2组患者治疗前后TNF-α水平的变化情况;④观察2组的不良反应情况.结果 ①治疗4周后,观察组的总有效率达86%,显著高于对照组68%(χ2=4.574,P=0.032).②治疗4周后,观察组与对照组的PASI评分分别为(4.6±0.6)分、(8.4±1.8)分,显著低于治疗前,且观察组PASI评分较对照组降低更显著(t=13.654,P<0.01).③治疗4周后,观察组与对照组的TNF-α水平分别为(6.6±1.0)、(12.6±2.5)pg/ml,均显著低于治疗前,且观察组TNF-α水平较对照组降低更显著(t=15.881 5,P<0.01).④2组不良反应率比较,观察组发生率均较低,其中皮肤干燥瘙痒发生率2组差异有统计学意义(χ2=21.236,P<0.05),未出现严重的毒副作用.结论 阿维A联合喜炎平注射液治疗斑块型银屑病的临床疗效显著,可明显改善患者皮损面积及严重程度,考虑可能是通过降低TNF-α水平从而抑制炎症进展而起到治疗银屑病的作用.%Objective To investigate the clinical efficacy and safety of acitretin capsule and Xiyanping injec-tion in the treatment of plaque psoriasis, and its effect on serum TNF-α in patients with plaque psoriasis. Methods A total of 100 patients with plaque psoriasis were randomly divided into two groups ( n=50 each), the study group (ac-itretin capsule and Xiyanping injection therapy) and the control group (acitretin capsule therapy), for 4 weeks. Com-parison: ①The total effective rate between the two groups after the treatment; ②Changes in PASI score between the two groups before and after the treatment; ③ Changes in TNF-α level between the two groups before and after the treatment; ④The adverse reactions between the two groups. Results ①At 4 weeks after the treatment, the total ef-fective rate in the study group reached 86%, which was significantly higher than the control group of 68% (χ2=4.574, P=0.032). ② At 4 weeks after the treatment, the PASI score in the study group and the control group was (4.6 ±0.6) points and (8.4±1.8) points, respectively, which was significantly lower than that before the treatment. The PASI score in the study group was significantly decreased compared with that in the control group ( t=13.654, P<0.01). ③At 4 weeks after the treatment, the TNF-α level in the study group and the control group was (6.6 ±1.0) pg/ml and (12.6 ± 2.5) pg/ml, respectively, which was significantly lower than that before the treatment. The TNF-α level in the study group was significantly decreased compared with that in the control group ( t=15.881 5, P<0.01). ④Comparing the ad-verse reaction rate between the two groups, the incidence of adverse reaction in the study group was lower than that in the control group. There was significant difference in the incidence of dry and itchy skin between the two groups (χ2=21.236, P<0.05). No severe toxic side effects occurred. Conclusion The clinical efficacy of acitretin capsule and Xiyanping injection in the treatment of plaque psoriasis is significant, which can significantly improve the area and severity of the skin lesion in patients. It may treat plaque psoriasis by reducing of TNF-αlevel to inhibit inflammation progress.
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