他克莫司联合度普利尤单抗治疗中、重度特应性皮炎的临床研究

Efficacy of tacrolimus combined with dupilumab in the treatment of moderate to severe atopic dermatitis

摘要:

目的 分析他克莫司联合度普利尤单抗治疗中重度特应性皮炎（AD）的效果。方法 前瞻性选取2018年2月—2023年2月贵阳市第二人民医院收治的102例中重度AD患者，按随机数字表法分为对照组、研究组，各51例。对照组给予度普利尤单抗，研究组给予他克莫司联合度普利尤单抗治疗，持续治疗3个月观察效果。对比两组皮损、瘙痒、临床疗效、炎症相关因子、嗜酸性粒细胞（EOS）、免疫球蛋白E（IgE）及治疗期间不良反应情况。结果 研究组治疗前后湿疹面积及严重程度指数评分、特应性皮炎积分指数评分的差值均高于对照组（P <0.05）。两组治疗前、治疗后1个月、治疗后3个月的VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（F =12.658，P =0.000）；②两组VAS评分比较，差异有统计学意义（F =10.457，P =0.000），研究组治疗后1个月、治疗后3个月的VAS评分均低于对照组；③两组VAS评分变化趋势比较，差异有统计学意义（F =8.967，P =0.000）。研究组总有效率高于对照组（P <0.05）。研究组治疗前后的白细胞介素-4、白细胞介素-25、腺基质淋巴细胞生成素、γ干扰素的差值均高于对照组（P <0.05）。研究组治疗前后EOS、IgE的差值均高于对照组（P <0.05）。两组总不良反应发生率比较，差异无统计学意义（P >0.05）。结论 他克莫司联合度普利尤单抗治疗中重度AD疗效显著，可改善患者症状及炎症相关因子合成，降低EOS、IgE水平，安全可靠。

Abstract:

Objective To analyze the efficacy of tacrolimus combined with dupilumab in the treatment of moderate to severe atopic dermatitis (AD).Methods The 102 patients with moderate to severe AD admitted to our hospital from February 2018 to February 2023 were prospectively selected, and were divided into the control group and the study group by the random number table method, with 51 cases in each group. The control group was given dupilumab, and the study group was given tacrolimus combined with dupilumab. The therapeutic efficacy was observed after continuous treatment for 3 months. The skin lesions, severity of itching, clinical efficacy, levels of inflammatory factors, eosinophils (EOS) and immunoglobulin E (IgE), and adverse reactions during the treatment were compared between the two groups.Results The differences of the Eczema Area and Severity Index and the Scoring Atopic Dermatitis index before and after the treatment in the study group were greater than those in the control group (P < 0.05). Visual Analogue Scale (VAS) scores before treatment, 1 month after treatment and 3 months after treatment in the two groups were compared, and the results showed that VAS scores were different at different time points (F = 12.658, P = 0.000) and between the two groups (F = 10.457, P = 0.000), where the VAS scores 1 month and 3 months after treatment in the study group were lower than those in the control group. Besides, the change trends of the VAS scores were different between the two groups (F = 8.967, P = 0.000). The overall effective rate of the study group was higher than that of the control group (P < 0.05). The differences of levels of interleukin-4, interleukin-25, thymic stromal lymphopoietin and interferon-γ before and after treatment in the study group were higher than those in the control group (P < 0.05). The differences of EOS and IgE before and after treatment in the study group were also higher than those in the control group (P < 0.05). There was no significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusions Tacrolimus combined with dupilumab is effective in the treatment of moderate and severe AD, which ameliorates symptoms and the synthesis of inflammatory factors and reduces the levels of EOS and IgE in a safe and reliable manner.