慢性荨麻疹的治疗

慢性荨麻疹是多数病因不明、病程长且治疗困难的皮肤病。作者复习有关文献介绍对慢性荨麻疹的非药物和药物治疗 ,其重点为药物治疗。     

Treatment of Refractory Chronic Urticaria

Chronic spontaneous urticaria is a distressing disease encountered frequently in clinical practice. The current mainstay of therapy is the use of second-generation, non-sedating antihistamines. However, in patients who do not respond satisfactorily to these agents, a variety of other drugs are used. This article examines the available literature for frequently used agents including systemic corticosteroids, leukotriene receptor antagonists, dapsone, sulfasalazine, hydroxychloroquine, H2 antagonists, methotrexate, cyclosporine A, omalizumab, autologous serum therapy, and mycophenolate mofetil, with an additional focus on publications in Indian literature.     

西可韦治疗荨麻疹疗效观察

目的：观察国产西可韦治疗急、慢性荨麻疹的疗效及安全性。方法：40例急、慢性荨麻疹患每天口服西可韦10mg治疗6天,与46例口服仙特敏治疗的患作对照,结果：西可韦治疗综合疗效的显效率和有效率分别为65.0％和85.0％,对荨麻疹主要症状和体征的显效率和有效率分别是风团为70．0％和97．5％、瘙痒为55.0％和90．0％。与对照组相比差异无显性意义。结论：西可韦是治疗荨麻疹的有效药物。     

Psychosomatic Treatment of a Case of Chronic Urticaria

A 35-year-old Japanese woman presented with urticaria in January of 1992. As her symptoms gradually became worse, she came to our hospital in March of that year. I treated her with various combinations of antihistaminics and antiallergics. However, her symptoms did not respond and continued to deteriorate. Although her blood was analyzed in an attempt to identify antigenic or physical factors, no positive data were obtained. Because three kinds of psychological tests showed that the patient was highly anxious and depressive, I additionally treated her with psychotropics and psychotherapy in May of 1994. After a month, the symptoms began to disappear. She has since been free from the symptoms while taking medicine only twice a week. Our group recently presented the efficacy of psychotropics in patients with chronic urticaria. This case suggests that highly anxious or depressive cases with chronic urticaria should be treated not only dermatologically, but also psychologically.     

慢性特发性荨麻疹与幽门螺杆菌关系和治疗的研究

目的探讨慢性特发性荨麻疹(chronic idiopathic urticaria,CIU)与幽门螺杆菌(Helicobacter pylori,HP)关系及其治疗效果.方法 300例CIU患者进行14碳-尿素呼气试验(14C urea-breath test,14C-UBT),176例HP阳性者随机分为三组,其中58例予抗过敏治疗、59例抗过敏联合三联疗法治疗、59例中药联合三联疗法治疗,观察内容包括瘙痒、风团数量、风团大小、风团持续时间,比较各组治疗效果、分析CIU与HP之间关系.另外57例CIU患者进行自身血清抗体检测,其中35例HP阳性者予抗过敏联合三联疗法治疗,相同治疗方法与呼气试验组比较转阴率.108例健康体检者作为对照(其中65例进行呼气试验,43例血清抗体检测),以便对HP阳性率进行分析.结果CIU患者HP阳性率明显高于健康组(P＜0.01).联合三联疗法(抗过敏联合三联疗法、中药联合三联疗法)与单纯抗过敏治疗相比,治疗效果明显优于后者(P＜0.05),转阴率也明显高于后者(P＜0.01).治疗后HP转阴与未转阴患者疗效比较,前者明显优于后者(P＜0.05).结论 CIU与幽门螺杆菌关系密切,中药联合三联疗法治疗CIU效果好.     

咪唑斯汀治疗慢性荨麻疹临床疗效观察

目的：评价咪唑斯汀治疗慢性荨麻疹的有效性及安全性。方法：对145例慢性荨麻疹患者应用咪唑斯汀（皿治林）10mg，每晚1次口服，治疗2周。结果：治疗后患者的症状总积分明显低于治疗前，痊愈率为70．3％，总有效率为90．3％，且无明显不良反应。结论：使用咪唑斯汀治疗慢性荨麻疹是安全有效的。     

咪唑斯汀治疗急性荨麻疹起效时间观察

目的　观察咪唑斯汀治疗急性荨麻疹起效时间及安全性。方法　对 41例急性荨麻疹患者采用咪唑斯汀 10mg ,1次 /d ,对患者首次服药后 3 0min、60min、90min、12 0min自觉症状及体征减轻开始的时间进行记录。对首次服药后 60min及 12 0min起效时间进行观察并评估疗效。结果　患者首次服药后 60min以内起效 12例 ( 2 9.2 6% ) ;12 0min总起效 2 4例 ( 5 8.5 4% ) ;12 0min起效为 3 6例 ( 87.80 % )。结论　咪唑斯汀治疗急性荨麻疹起效时间快并且有良好的安全性和药物耐受性。     

慢性荨麻疹伴甲状腺疾病的诊治方法探讨

目的探讨总结慢性荨麻疹伴自身免疫性甲状腺疾病的诊治方法。方法对我院2000年~2004年收治的8例确诊为慢性荨麻疹伴甲状腺自身免疫性疾病的临床资料进行回顾性分析。结果8例中,7例的FT3(25.81±3.50)pmol/L,FT4(60.56±6.20)pmol/L,均明显高于正常值,uTSH(0.116±0.012)m IU/L明显低于正常值,给予抗甲亢、手术和抗组胺等同时治疗后,荨麻疹与甲亢症状消失。结论对于原因不明的慢性荨麻疹患者,应作甲状腺功能检查。若伴甲状腺疾病者应同时给予抗组胺并针对甲状腺疾病进行治疗。     

咪唑斯汀治疗慢性荨麻疹临床疗效观察

目的　观察咪唑斯汀治疗慢性荨麻疹的临床疗效及安全性。方法　口服咪唑斯汀 10mg ,1次 /d ,同时配以维生素及钙剂口服 ,分别于 1周、2周后观察并判定疗效 ;并设西替利嗪为对照。结果　治疗慢性荨麻疹共 34例 ,在1周、2周时有效率分别为 88%、85 % ,与对照组相比 ,差异具有高度显著性。结论　咪唑斯汀具有抗组胺和抗炎症介质的双重作用 ,用于慢性荨麻疹具有较好的疗效与安全性。     

氯雷他定片治疗慢性荨麻疹的临床观察

目的评价氯雷他定片治疗慢性荨麻疹的疗效和安全性。方法将106例患者随机分为两组,各53例。治疗组给予氯雷他定片10mg,1次/d;对照组给予咪唑斯汀缓释片10mg,1次/d治疗。两组均治疗28天判效。结果对总体疗效而言,意向性分析结果显示两组有效率分别为66.04%和62.26%,方案数据分析结果显示两组总有效率分别为68.00%和64.71%,总体疗效差异与症状积分改善等均无统计学意义(P>0.05),两组具有临床上的非劣性(P<0.05)。临床观察中未发现明显毒副作用和不良反应。结论氯雷他定片治疗慢性荨麻疹安全有效,可在临床上推广应用。     

地氯雷他定联合潘生丁治疗慢性荨麻疹疗效观察

目的观察地氯雷他定联合潘生丁治疗慢性荨麻疹疗效和安全性。方法64例自体血浆皮肤试验(APST)阳性的慢性荨麻疹患者随机分为治疗组和对照组,治疗组口服地氯雷他定5mg1次/d和潘生丁25mg3次/d;对照组单用地氯雷他定,用法同治疗组,疗程均为28天,疗程结束时评价疗效及不良反应;并采用酶联免疫吸附法(ELISA)检测患者治疗前后血浆凝血酶原片段F1+2水平。结果治疗组和对照组的有效率分别为85.29%和70.58%,两组比较差异有显著性(P<0.05);血浆F1+2水平治疗后明显降低(P<0.001),其中治疗前治疗组与对照组为3.34±2.87和3.19±2.64;(P>0.05),治疗后为0.94±0.58和1.15±1.12(P<0.05)。结论地氯雷他定联合潘生丁可提高慢性荨麻疹的临床疗效且无明显不良反应,血浆F1+2水平的升高可能在慢性荨麻疹发病中具有重要意义。     

盐酸左西替利嗪联合卡介菌多糖核酸治疗慢性荨麻疹的疗效观察

目的探讨左西替利嗪联合卡介菌多糖核酸治疗慢性荨麻疹的临床疗效及安全性。方法将118例患者随机分为两组,治疗组口服左西替利嗪5mg,1次/d,同时给予斯奇康注射液1mg(2mL)肌注,1次/2d。对照组单纯口服左西替利嗪5mg,1次/d。疗程3周。观察两组的疗效及不良反应。结果治疗组的疗效明显优于对照组(P<0.05);不良反应治疗组出现2例,对照组出现3例。结论左西替利嗪联合斯奇康注射液治疗慢性荨麻疹安全、有效。     

左西替利嗪治疗慢性荨麻疹疗效观察

目的观察盐酸左西替利嗪治疗慢性荨麻疹的疗效。方法分别用盐酸左西替利嗪(治疗组)和盐酸西替利嗪(对照组)治疗慢性荨麻疹,比较临床疗效及不良反应。结果左西替利嗪组有效率(84.84%)高于西替利嗪组(80.64%),但差异无显著性(P>0.05),治疗组不良反应发生率较低。结论盐酸左西替利嗪治疗慢性荨麻疹安全有效。     

五味子汤治疗慢性风寒束表型荨麻疹疗效分析

目的观察五味子汤对慢性风寒束表型荨麻疹的有效性和安全性。方法采用随机、双盲对照法,共治疗86例患者。试验组46例,口服五味子汤,1剂/d分早晚服;对照组40例,口服氯雷他定10 mg,每晚1次,连用4周,两组病例均停药观察12周。结果试验组有效率为82.26%,对照组有效率82.50%,两组疗效无显著性差异(χ2=0.096,P>0.05);停药后随访3个月,试验组复发率16.67%,对照组为76.19%,两组复发率有显著性差异(χ2=18.07,P<0.01);试验组不良反应发生率为10.8%,对照组为7.5%。结论五味子汤对慢性风寒束表型荨麻疹的近期疗效与口服氯雷他定相似,而远期疗效明显优于氯雷他定,复发率较低,耐受性好,无严重不良反应。     

Urticaria

Urticaria and angioedema are common and, if chronic, often persist for years with significant impact on quality of life and occupational ability. To achieve a better understanding of disease etiology and pathogenesis and to compare clinical trials, there is a clear need for cross‐specialty and international agreement of the nomenclature and diagnostic classification of urticaria and angioedema. At least in part this has been achieved by two recently published European guidelines. After the urticaria subtype is defined, potential triggers should be sought including persistent bacterial infections (Helicobacter pylori, streptococci, staphylococci, Yersinia, parasites) pseudoallergic reactions (acetylsalicylic acid, rarely food additives) and/or autoreactive mechanisms (autologous serum test). Identified trigger factors should be avoided or eradicated, as this is the most successful therapeutic approach. Treatment of most urticaria subtypes is difficult and besides H1 antihistamines neither standardized nor evidence‐based. Low‐sedating H1 antihistamines represent the mainstay of treatment, as they have a better therapeutic index and pharmacodynamic properties than older agents. In severe cases their dose has to be increased which is off‐label use. The evidence base for treatment alternatives is totally insufficient and the risk‐benefit profile of each off‐label used drug should be carefully considered.     

Urticaria

Urticaria is a very common skin disease which was already described in the ancient world. Questions still remain about its pathogenesis and management remain open. Compared to other common skin diseases, the published evidence is rather low. The clinical symptoms with pruritic transient wheals and/or angioedema are caused by mediators (particularly histamine) released by activated mast cells and basophils. The mechanism of target cell activation has not been clarified in detail for most urticaria subtypes. Different urticaria subtypes should be distinguished. Spontaneous forms are more common than inducible forms. Chronic urticaria and urticaria in certain age groups (children, pregnancy) can be difficult to manage. Therefore, international consensus resulting in the regular update of urticaria guidelines can be very helpful. Currently, these updated guidelines include a three‐step treatment algorithm for chronic spontaneous urticaria. Only the first step of this algorithm, second generation H1‐antihistamine in standard dose, utilized approved drugs. However after omalizumab was established as a third line choice in the guideline algorithm, it has approved in many countries for chronic spontaneous urticaria without response to H1‐antihistamines. The exact mechanism of action of omalizumab in urticaria has not been fully elucidated. Unrevealing this mechanism might result in a deeper understanding of urticaria pathogenesis and the development of further therapeutic strategies.