><STRONG>选自——《银屑病中西医结合治疗》</STRONG></P>
><FONT size=2>钙泊三醇是骨化三醇<FONT face="Times New Roman">[1</FONT>,<FONT face="Times New Roman">25(OH)2D3]</FONT>的类似物,是一种全新的维生素<FONT face="Times New Roman">D3</FONT>类似物,它与维生素<FONT face="Times New Roman">D3</FONT>受体的亲和力与骨化三醇相同,但对血钙影响极低,仅为骨化三醇的<FONT face="Times New Roman">0.5</FONT>%~<FONT face="Times New Roman">1.0</FONT>%。。。。。。钙泊三醇于<FONT face="Times New Roman">1987</FONT>年由丹麦利昂制药公司合成,<FONT face="Times New Roman">1991</FONT>年开始在欧洲一些国家上市用于治疗寻常型银屑病,主要用于治疗轻度到中度的斑块型银屑病,其疗效类似中效或强效的皮质类固醇软膏。他骨化醇对维生素<FONT face="Times New Roman">D3</FONT>受体亲和力及体外疗效与骨化三醇相似,而诱发高血钙、皮肤刺激等的副作用小。<FONT face="Times New Roman">1</FONT>×<FONT face="Times New Roman">10-7 M</FONT>的他骨化醇可使<FONT face="Times New Roman">90</FONT>%的细胞生长被抑制,<FONT face="Times New Roman">59</FONT>%的细胞<FONT face="Times New Roman">DNA</FONT>合成受抑制,分化细胞从<FONT face="Times New Roman">6</FONT>.<FONT face="Times New Roman">4</FONT>%上升到<FONT face="Times New Roman">24</FONT>.<FONT face="Times New Roman">1</FONT>%。<BR></FONT><FONT size=2>此类药物的副作用主要是局部皮肤刺激,表现为烧灼、瘙痒、红斑、脱屑、干燥。肾功能不全者,或超大量大面积使用,或患者已存有钙代谢轻度紊乱,可出现高血钙、高尿钙症,表现为头痛嗜睡、肌无力、恶心呕吐等。皮损改善后即停止用药,虽然没有如停用糖皮质激素样的反跳现象,但银屑病仍然可以逐渐复发,所以一般需要继续间歇性地使用以维持疗效。</FONT></P>
mso-char-indent-count: mso-char-indent-size: 10.5pt? 0cm 0pt; TEXT-INDENT: 21.75pt; 2.07;><FONT size=2>临床应用</FONT></P>
mso-char-indent-count: mso-char-indent-size: 10.5pt? 0cm 0pt; TEXT-INDENT: 21.75pt; 2.07;><FONT size=2>临床研究表明外用钙泊三醇的浓度为<FONT face="Times New Roman">0</FONT>.<FONT face="Times New Roman">005</FONT>%较好,此浓度疗效明显优于<FONT face="Times New Roman">0</FONT>.<FONT face="Times New Roman">0025</FONT>%,而与<FONT face="Times New Roman">0</FONT>.<FONT face="Times New Roman">010</FONT>%无明显区别。一般每日早晚<FONT face="Times New Roman">2</FONT>次,外用面积在体表面积的<FONT face="Times New Roman">40</FONT>%以内,剂量每周不超过<FONT face="Times New Roman">100g</FONT>时安全度很高,钙代谢不会受到影响,可不必监测血、尿钙的水平。用药后<FONT face="Times New Roman">1</FONT>周内皮损改善不明显,并且容易出现皮肤刺激性副作用,<FONT face="Times New Roman">2</FONT>周后开始出现效果,同时副作用减轻,<FONT face="Times New Roman">4</FONT>周左右时效果显著,一般<FONT face="Times New Roman">6</FONT>周为一疗程。可与糖皮质激素联合使用,联合用药疗效优于单一用药。临床医生对本药的总体评价是:基本痊愈率为<FONT face="Times New Roman">27</FONT>.<FONT face="Times New Roman">8</FONT>%、显著改善率为<FONT face="Times New Roman">49</FONT>.<FONT face="Times New Roman">1</FONT>%。对慢性斑块型银屑病患者,采用钙泊三醇与倍他米松联合应用的疗效优于单用药,即每天早晨用钙泊三醇软膏<FONT face="Times New Roman">1</FONT>次、每天晚上用<FONT face="Times New Roman">0</FONT>.<FONT face="Times New Roman">1</FONT>%倍他米松戊酸酯。</FONT></P>
mso-char-indent-count: mso-char-indent-size: 10.5pt? 0cm 0pt; TEXT-INDENT: 21.75pt; 2.07;><FONT size=2>外用<FONT face="Times New Roman">0</FONT>.<FONT face="Times New Roman">005</FONT>%钙泊三醇观察治疗慢性斑块状银屑病患者长达一年的报道,未发现类似皮质类固醇样的皮肤萎缩和反跳现象,总有效率为<FONT face="Times New Roman">95</FONT>%左右,证明钙泊三醇对慢性斑块状银屑病不失为一种安全有效的外用药。对寻常型斑块状银屑病患者进行为期<FONT face="Times New Roman">6</FONT>个月的治疗,结果显效率为<FONT face="Times New Roman">54</FONT>.<FONT face="Times New Roman">1</FONT>%,有效率为<FONT face="Times New Roman">93</FONT>.<FONT face="Times New Roman">3</FONT>%。对寻常型、稳定期、皮损面积<FONT face="Times New Roman"><</FONT>体表面积的<FONT face="Times New Roman">50</FONT>%,<FONT face="Times New Roman">2</FONT>周内未曾用过皮质类固醇和钙剂的患者,每天外涂<FONT face="Times New Roman">2</FONT>次,每周用量不超过<FONT face="Times New Roman">100g</FONT>。结果显示,钙泊三醇软膏在稳定期银屑病中具有良好的疗效,临床显效率和有效率分别在<FONT face="Times New Roman">78</FONT>.<FONT face="Times New Roman">0</FONT>%左右、<FONT face="Times New Roman">96</FONT>.<FONT face="Times New Roman">7</FONT>%左右,有效以上的评价率达<FONT face="Times New Roman">94</FONT>%以上。以鳞屑减少为最快最多,依次为浸润、红斑。用药<FONT face="Times New Roman">2</FONT>~<FONT face="Times New Roman">4</FONT>周时效果显著,<FONT face="Times New Roman">6</FONT>周后改善减缓。疗效优于皮质类固醇,且无反跳现象。有<FONT face="Times New Roman">10</FONT>%的患者用药后出现局部潮红、瘙痒、灼热及干燥,但反应较轻而短暂,不需处理。另一报道,每晚外涂<FONT face="Times New Roman">0</FONT>.<FONT face="Times New Roman">0015</FONT>%骨化三醇观察治疗皮损面积超过体表面积<FONT face="Times New Roman">10</FONT>%的稳定期斑块型或红皮病型银屑病患者,进行为期<FONT face="Times New Roman">2</FONT>.<FONT face="Times New Roman">4</FONT>个月±<FONT face="Times New Roman">1</FONT>个目治疗,<FONT face="Times New Roman">
ASI</FONT>计分显示,治疗区治疗指数减少<FONT face="Times New Roman">60</FONT>.<FONT face="Times New Roman">8</FONT>%±<FONT face="Times New Roman">3</FONT>.<FONT face="Times New Roman">0</FONT>%;<FONT face="Times New Roman">12</FONT>个月后,<FONT face="Times New Roman">90.9</FONT>%呈现卓越或中等以上疗效,<FONT face="Times New Roman">9</FONT>.<FONT face="Times New Roman">1</FONT>%有轻度改善。组织学检查,治疗区皮损角层厚度明显变薄,颗粒层明显,且无白细胞渗入,毛细血管周围仅有少许淋巴细胞浸润。</FONT></P>
mso-char-indent-count: mso-char-indent-size: 10.5pt? 0cm 0pt; TEXT-INDENT: 21.75pt; 2.07;></P>
mso-char-indent-count: mso-char-indent-size: 10.5pt? 0cm 0pt; TEXT-INDENT: 21.75pt; 2.07;><FONT size=2>以上内容可详细阅读:</FONT></P>
mso-char-indent-count: mso-char-indent-size: 10.5pt? 0cm 0pt; TEXT-INDENT: 21.75pt; 2.07;><FONT size=2><a href="http://www.yxb365.com/bbs/dispbbs.asp?boardID=8&ID=2068&page=1" target="_blank" >http://www.yxb365.com/bbs/dispbbs.asp?boardID=8&ID=2068&page=1</A></FONT></P>
mso-char-indent-count: mso-char-indent-size: 10.5pt? 0cm 0pt; TEXT-INDENT: 21.75pt; 2.07;><FONT size=2><STRONG><U>仅供参考,具体用药规范,建议到医院皮科找医生咨询。</U></STRONG></FONT></P>
>能具体介绍一下和哪种激素药使用效果好些,谢谢倦客大哥</P>| 欢迎光临 银屑病病友互助网 (https://www.yxb365.com/) | Powered by Discuz! X3.2 |