摘要
目的分析托法替布治疗中重度斑秃的疗效及安全性。方法回顾性分析2021年10月——2025年3月江门市五邑中医院皮肤科诊断为中重度斑秃的21例患者,包括重度10例,中度11例。采用口服托法替布片5 mg/次,2次/d,局部外用5%米诺地尔搽剂、卤米松乳膏。治疗6个月后可联合其他治疗,以托法替布停药或者减量截至5 mg/d为观察结束。利用脱发严重程度工具(SALT)评估疗效,并比较中重度组之间的疗效差异,同时观察不良反应。结果6个月后采用联合激素、中药、低能量激光、微针及富血小板血浆等治疗者14例,其中5例联合激素治疗,激素减停时间2~6个月。治疗前21例患者平均SALT评分为51.19±20.96,治疗3个月、6个月、观察结束后分别为31.33±17.08、5.95±5.75、4.09±2.71分,与治疗前比较,差异均有统计学意义(t值分别为10.92、10.65、9.77,均P<0.01)。治疗3个月、6个月、观察结束后,SALT评分下降率分别为(42.68±12.22)%、(86.76±7.52)%、(92.24±4.34)%。重度组在治疗3个月时SALT评分下降率低于中度组(Z=-2.01,P<0.05),而治疗6个月和观察结束后与中度组比较无明显差异。重度组托法替布应用时间为[9(8.5,14)]个月,中度组为[4(4,7)]个月,差异有统计学意义(Z=-3.34,P<0.01)。治疗期间未出现严重不良反应。结论托法替布治疗中重度斑秃有效,不良反应轻微。重度斑秃患者起效较慢,且需要更长时间的治疗。
Objective To analyze the efficacy and safety of tofacitinib in the treatment of moderate to severe alopecia areata.Methods A retrospective analysis was performed on 21 patients with alopecia areata,including 11 moderate cases and 10 severe cases,who were treated at the Department of Dermatology,Wuyi Hospital of Traditional Chinese Medicine,Jiangmen City,between October 2021 and March 2025.Patients were treated with oral tofacitinib(5 mg twice daily),topical 5%minoxidil tincture,and halometasone cream for six months.Subsequently,other treatments were administered until tofacitinib was discontinued or its dose was reduced to≤5 mg daily.Efficacy was assessed using the severity of alopecia tool(SALT)and compared between moderate and severe groups.Adverse reactions were observed at the same time.Results After 6 months,14 cases received combined treatment,including glucocorticoids,Chinese medicine,a laser at low energy level,microneedle therapy and platelet-rich plasma therapy.Combined glucocorticoid therapy was administered in six cases.The time to dose reduction and discontinuation was 2~6 months.ALT scores were significantly reduced from baseline to 3 months,6 months,and the end of treatment(values:51.19±20.96 at baseline,31.33±17.08 at 3 months,5.95±5.75 at 6 months,4.09±2.71 at end of treatment.t=10.92,10.65,and 9.77,respectively.P<0.01 for all).The SALT scores were reduced from baseline by 42.68±12.22%at 3 months,86.76±7.52%at 6 months,and 92.24±4.34%at the end of treatment.The severe group exhibited a significantly lower rate of reduction in SALT scores at 3 months compared to the moderate group(Z=-2.01,P<0.05).No significant intergroup differences were observed at the 6-month or end of the observation period.Treatment duration differed significantly between the groups,with a longer median duration in the severe group[9 months(IQR 8.5~14)]than in the moderate group[4 months(IQR 4~7)](Z=-3.34,P<0.01).No serious adverse reactions were reported during treatment.Conclusions Tofacitinib is effective for moderate and severe alopecia areata and is well-tolerated.However,treatment response is slower in patients with severe alopecia areata,requiring a longer course of therapy.
作者
王福军
付丽淼
蒋琪
于文沛
阳忠辉
冯全娣
马常青
钟鸣
WANG Fujun;FU Limiao;JIANG Qi;YU Wenpei;YANG Zhonghui;FENG Quandi;MA Changqing;ZHONG Ming(Jiangmen Wuyi Hospital of Chinese Medicine,Jiangmen 529000,China;School of Traditional Chinese Medicine,Jinan University,Guangzhou 510632,China)
出处
《皮肤性病诊疗学杂志》
2025年第9期637-642,共6页
Journal of Diagnosis and Therapy on Dermato-venereology
基金
江门市医疗卫生领域科技计划项目(2022YL03013,2024YL02010)。
关键词
斑秃
JAK抑制剂
托法替布
SALT评分
微针
回顾分析
alopecia areata
jak inhibitor
tofacitinib
salt score
microneedle therapy
restrospective analysis
