目的 探讨肿瘤坏死因子(TNF)-α拮抗剂治疗自身免疫性疾病患者诱发或加重银屑病的临床特征、治疗和预后.方法 计算机检索Medline、Springerlink、Sciencedirect、Wiley、Web of Science、CNKI、万方数据库和CBM数据库,纳入国内外文献中公开发表的TNF-α拮抗剂治疗中诱发或加重银屑病患者的临床资料进行荟萃分析.结果 本研究纳入27篇文献,共78例患者[33例类风湿关节炎、18例克罗恩病、9例银屑病性关节炎、9例强直性脊柱炎、2例adamantiades-behçet病和2例幼年特发性关节炎,血清阴性脊柱关节病、溃疡性结肠炎、血清阴性脊柱关节病合并克罗恩病,白塞病、SAPHO综合征各1例].临床特征如下:①女性多见;以中老年为主;②临床常用的TNF-α拮抗剂依那西普、英夫利昔单抗和阿达木单抗均可诱发银屑病皮损;③出现不良反应时间差异较大,4d～72个月,但大多数患者在治疗的第1年内出现银屑病皮损.④新发银屑病类型主要是脓疱性银屑病,其中掌跖脓疱病最常见,其次为寻常性银屑病;⑤以局部使用糖皮质激素治疗为主,多数患者皮损可改善,少数严重者需要全身治疗,也有少数患者需更换为另外一种TNF-α拮抗剂或中止TNF-α拮抗剂治疗;⑥多数患者皮损的临床特点与组织病理学特点相符;⑦少数患者有个人及家族银屑病史;⑧少数患者有吸烟史.结论 在自身免疫性疾病患者中,TNF-α拮抗剂可诱发或加重银屑病.临床上应该密切观察可能出现的不良反应,根据患者具体情况,选择最佳治疗方法.
Psoriasis induced or aggravated by tumor necrosis factor-alpha antagonists in the treatment of autoimmune diseases:a meta-analysis
Objective To investigate the clinical features,treatment and prognosis of psoriasis induced or aggravated by tumor nrctosis factor-alpha(TNF-α)antagonists in the treatment of autoimmune diseases.Methods Medline,Springerlink,Sciencedirect,Wiley,Web of Science,CNKI,Wanfang and CBM database were retrospectively searched for the clinical data on patients with psoriasis induced or aggravated by TNF-α antagonist therapy,as reported in both domestic and international literature.These data were then subjected to a meta-analysis.Results A total of 27 articles were incorporated into tihs study,including 78 patients(33 cases with rheumatoid arthritis,18 with Crohn's disease,9 with psoriatic arthritis,9 with ankylosing spondylitis,2 with ABD,2 with juvenile idiopathic arthritis,1 with seronegative spondyloarthropathy,1 with ulcerative colitis,1 with seronegative spondyloarthropathy and Crohn's disease,1 with Behcet's disease,and 1 with SAPHO syndrome).Their clinical features including:(1)Higher prevalence in women,particularly among middle-aged and older individuals.(2)Psoriatic can be induced by commonly used TNF-α antagonists,such as etanercept,infliximab,and adalimumab.(3)The occurrence of adverse reactions ranged from a minimum of 4 days to a maximum of 72 months.However,most patients developed psoriatic within the first year of treatment.(4)The main type of newly induced psoriasis was pustular psoriasis,with palmoplantar pustulosis being the most common,followed by vulgar psoriasis.(5)The psoriasis induced by TNF-α antagonists can be effectively managed with topical corticosteroids in most patients.However,a small proportion of severe cases may necessitate systemic treatment.Additionally,some patients may need to switch or discontinue TNF-α antagonist therapy.(6)The clinical features of most patients with skin lesions aligned with histopathological findings.(7)A small number of patients had a personal or family history of psoriasis.(8)A small number of patients havd a history of smoking.Conclusion TNF-α antagonists can induce or aggravate psoriasis in patients with autoimmune diseases.In clinical practice,potential adverse reactions should be closely monitored,and the best treatment strategy should be selected based on the specific situation of the patient.
万方数据
维普
