张超 王娇 陈蕊 陈自盈

[摘要] 目的 进行阿维A与甲氨蝶呤治疗泛发性脓疱型和红皮病型银屑病的疗效及安全分析。 方法 随机选取该院2009年4月—2014年3月收治泛发性脓疱型和红皮病型银屑病患者200例随机分组，对照组患者给予阿维A治疗，观察组患者给予甲氨蝶呤治疗，对比疗效和安全性。结果 对照组中泛发性脓疱型银屑病患者总有效率为94.0%；红皮病型银屑病患者总有效率为78.0%。观察组中泛发性脓疱型银屑病患者总有效率为76.0%；红皮病型银屑病患者总有效率为98.0%。两组的总治疗效果差异无统计学意义（P>0.05）。观察组患者不良反应明显少于对照组（P<0.05）。结论 从疗效上看，阿维A与甲氨蝶呤治疗泛发性脓疱型和红皮病型银屑病的疗效相当，但阿维A治疗泛发性脓疱型银屑病患者效果更为显著，而甲氨蝶呤治疗红皮病型银屑病患者效果更显著，两者在治疗上有偏侧点，需要根据银屑病的类型进行选择。而从安全性方面来看，甲氨蝶呤安全性更高。

[关键词] 阿维A；甲氨蝶呤；泛发性脓疱型；红皮病型银屑病；疗效；安全

[中图分类号] R75 [文献标识码] A [文章编号] 1674-0742（2015）08（c）-0115-02

Efficacy and Safety of Avermectin A and Methotrexate in the Treatment of Generalized Pustular and Erythrodermic Psoriasis

ZHANG Chao， WANG Jiao， CHEN Rui ， CHEN Zi-ying

The Skin Department， Changsha Central Hospital， Changsha， Hunan Province， 410004 China

[Abstract] Objective The curative effect and safety analysis of avermectin A and methotrexate in the treatment of generalized pustular and erythrodermic psoriasis. Methods The 200 patients were randomized into the hospital in 2009 April -2014 year in March from generalized pustular and erythrodermic psoriasis， the control group were treated with acitretin A treatment， observation group were treated with methotrexate treatment， comparing the efficacy and safety. Results In the control group， pustular psoriasis， the total effective rate was 94.0%； erythrodermic psoriasis patients， the total effective rate was 78.0%. Observation group pustular psoriasis patients， the total effective rate was 76.0%； erythrodermic psoriasis patients， the total effective rate was 98.0%. No significant difference in the overall therapeutic effect of the two groups （P> 0.05）. Adverse reactions observed in patients was significantly less than the control group （P <0.05）. Conclusion From the perspective effect， Avi A and methotrexate therapy generalized pustular and erythrodermic psoriasis quite， but Avi A treatment of generalized pustular psoriasis is more effective is significant， and methotrexate therapy in patients with erythrodermic psoriasis more significant effect， both in the treatment of unilateral point， you need to be selected according to the type of psoriasis. From the safety point of view， methotrexate higher security.

[Key words] Avi A； Methotrexate； Pustular type； Erythrodermic psoriasis； Efficacy； Safety

银屑病是以头皮、背部、四肢伸侧等部位出现红斑鳞屑为主要临床表现的一种慢性炎症性皮肤疾病[1]。银屑病分寻常型、脓疱型、关节型、红皮病型等多种分型，其中，寻常型银屑病的患者占到99%以上，其他类型的银屑病也多由寻常型银屑病转化而来。银屑病具有病程长、易反复的特点，根治比较困难。长期患者会对患者的身心健康造成严重的伤害。阿维A具有促进表皮细胞分化和增殖等作用，而甲氨蝶呤属于叶酸还原酶抑制剂，临床上有研究表明两者对治疗银屑病均有一定的效果。为了探讨阿维A与甲氨蝶呤治疗泛发性脓疱型和红皮病型银屑病的疗效及安全，该研究选取了相关病例进行研究，现报道如下。