炎症标记物辅助评估银屑病活动度以及依那西普疗效

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Clin Exp Dermatol. 2011 Jul 25. doi: 10.1111/j.1365-2230.2011.04131.x. [Epub ahead of print]   The role of inflammatory markers in assessing disease severity and response to treatment in patients with psoriasis treated with etanercept.   Kanelleas A, Liapi C, Katoulis A, Stavropoulos P, Avgerinou G, Georgala S, Economopoulos T, Stavrianeas NG, Katsambas A.   Source Second Department of Dermatology and Venereology, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece Department of Pharmacology, School of Medicine, National and Kapodistrian University of Athens, Greece First Department of Dermatology and Venereology, A. Sygros Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece Second Department of Internal Medicine, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece.   Abstract Background.   Psoriasis is a chronic, systemic, inflammatory disease. Inflammatory markers are used in clinical practice to detect acute inflammation, and as markers of treatment response. Etanercept blocks tumour necrosis factor (TNF)-α, which plays a central role in the psoriatic inflammation process. Aim.  To reveal any possible association between disease severity [measured by Psoriasis Area and Severity Index (PASI)] and the inflammatory burden (measured by a group of inflammatory markers), before and after etanercept treatment. Methods.  In total, 41 patients with psoriasis vulgaris, eligible for biological treatment with etanercept, were enrolled in the study. A set of inflammatory markers was measured, including levels of white blood cells and neutrophils, fibrinogen, ferritin, high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), haptoglobin, ceruloplasmin and α1-antitrypsin, before and after 12 weeks of etanercept 50 mg twice weekly. Results.  All markers were reduced after treatment (P < 0.001). PASI correlated with fibrinogen and hs-CRP. Of the 41 patients, 19 (46.3%) achieved reduction of 75% in PASI (PASI75). An increase in hs-CRP and ESR difference (values before minus values after treatment) was related to higher likelihood of achieving PASI75. Conclusions.  Inflammatory markers, particularly hs-CRP and to a lesser extent, fibrinogen and ESR, can be used to assist in assessing disease severity and response to treatment in patients with psoriasis. A combination of selected inflammatory factors (which we term the Index of Psoriasis Inflammation) in combination with PASI might reflect inflammatory status in psoriasis more accurately than each one separately.   © The Author(s). CED © 2011 British Association of Dermatologists.   PMID: 21790728

炎症标记物辅助评估银屑病活动度以及依那西普疗效   Kanelleas A, et al. Clin Exp Dermatol. 2011 Jul 25.提前在线.     背景: 银屑病是一种慢性、系统性、炎症性疾病。在临床实践中炎症标志物用于检测急性炎症，也可作为治疗应答的标志物。依那西普能阻断肿瘤坏死因子(TNF)-a，后者在银屑病炎症过程中有重要作用。 目的: 探求在依那西普治疗前后，疾病活动度(用PASI评分来反映)与炎症负担(用一组炎症标记物来衡量)之间的任何可能的相关性。 方法: 总的来说, 41例寻常型银屑病患者符合依那西普适应证的病人被纳入本研究。在每周一次50mg依那西普治疗12周前后，检测一组炎症标记物表达水平，包括外周血白细胞、中性粒细胞、纤维蛋白原、铁蛋白、高敏C反应蛋白(hs-CRP)、红细胞沉降率(ESR)、结合珠蛋白、血浆铜蓝蛋白和a1-抗胰蛋白酶。 结果: 所有标记物表达水平均在治疗后降低(P < 0.001)。PASI评分与纤维蛋白原和hs-CRP表达水平有相关性。41例病人中，19例(46.3%银屑病皮损改善达到PASI75。hs-CRP和ESR治疗前后的差异越大(治疗前后数值相减)，获得PASI75的可能性越高。 结论: 炎性标记物，尤其是hs-CRP以及相关性稍差一些的纤维蛋白原和ESR，可以辅助评估疾病活动度以及依那西普治疗银屑病的应答。将特定炎症组合(我们称之为银屑病炎症指数)与PASI结合起来，就可能比使用单一因素更准确地反应银屑病炎症状态。