小剂量甲氨蝶呤治疗成人慢性湿疹的疗效及安全性观察

目的 观察小剂量免疫抑制剂甲氨蝶呤对慢性复发性湿疹患者的治疗效果及安全性.方法 选择2009至2010年在我院皮肤科门诊就诊的成人慢性湿疹患者40例,入选患者均经过长时间的抗组胺及外用激素类软膏效果不佳,反复发作.每周给予甲氨蝶呤10mg一次顿服,第2日起给予叶酸5mg,tid口服;皮损局部处理依据皮疹性质对症处理.采用EASI评分表进行疗效评价;治疗前后及治疗过程定期行胸片、血尿常规、肝功能检测,评估其治疗的安全性.结果 治疗第6周和第8周总有效率分别达到76.31％和81.58％;半年复发率为15.62％.在治疗过程中,只有少数患者出现胃肠道反应、头痛、月经延长等轻微不良反应,未见肝肾功能损害、肺纤维化、造血功能抑制等严重不良反应.结论 口服甲氨蝶呤对一般抗组胺药物及外用激素软膏治疗无效的成人患者具有良好的疗效,毒副反应小,治疗安全性高,值得临床推广.

Observation the clinical efficacy and safety of low dosage methotrexate therapy in adults with chronic eczema

Objective To further determine the efficacy and safety of low dosage methotrexate therapy in adults with chronic eczema. Methods Forty adult patients with chronic eczema treated by methotrexate in our dermatology clinic from 2009 to 2010 had been chosen in the study. All had failed prolonged therapy with oral anti-histamines and local corticosteroid creams. 10 mg of methotrexate was given orally once a week along with folic acid supplements 6 days a week. Additional therapies included mollient cream. During the entire treatment blood test, urea, liver and kidney function test and chest X-ray check were regularly conducted and evaluated the safety.Results The evaluation was made on EMSI assessment after 6 and 8 weeks of MTX use, and showed that 76.31% （29/38） and 31/38（ 81.58% ）of patients improved; recurrence rate in half year was 15.62%. There were only slight adverse effects like gastrointestinal tract, headache, menstrual extension, without any severe adverse reactions like hepatorenal function, pulmonary fibrosis and hematopoiesis function during the treatment.Conclusions Taking methotrexate orMly is an effective and safe therapeutic alternative method for adults with chronic eczema in patients unresponsive to local and other systemic therapies. No serious adverse effects occur and it＇ s worthy for clinical application.