Low-dose cyclosporin A microemulsion in children with severe atopic dermatitis:: Clinical and immunological effects
Low-dose cyclosporin A microemulsion in children with severe atopic dermatitis:: Clinical and immunological effects
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DOI：
10.1034/j.1399-3038.2001.012004216.x
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发表时间：
2001-08-01
影响因子：
4.4
通讯作者：
Wahn, U
中科院分区：
文献类型：
--
作者：
Bunikowski, R;Staab, D;Wahn, U
环孢素A（CsA）是治疗儿童特应性皮炎（AD）的有效药物。通过以低剂量开始，治疗安全性应进一步增加。本研究的目的是评估小剂量环孢素A在儿童AD的临床结果和调制的T细胞失调。在一项开放性前瞻性研究中，10名患有重度AD的儿童（年龄：22-106个月）（两次基线测量的平均客观SCORAD评分> 40，至少间隔2周）接受了8周的CsA溶液治疗。所有患者均接受2.5 mg/kg/天的起始剂量，在无应答者中逐步增加至最大剂量5 mg/kg/天。使用SCORAD指数监测疾病活动。通过细胞内细胞因子染色分析外周血T淋巴细胞产生精氨酸的频率，并通过荧光激活细胞分选仪（FACS）分析测量T细胞数量。20名年龄匹配的健康儿童作为免疫学数据的对照。10例患者中有9例的SCORAD降低至少35%。在7例患者中，使用2.5 mg/kg/dav（n = 4）和3.5 mg/kg/d（n = 3）的低剂量CsA实现了这一目标。9名应答者中有7名在4周随访期内未复发。在基线时，患者组中白细胞介素-4（IL-4）、IL-13和人类白细胞抗原（HLA）-DR阳性CD 3（+）细胞的百分比高于对照组。CsA治疗后，干扰素-γ（IFN-γ）、IL-2、IL-4、IL-13显著降低。和HLA-DR阳性的CD 3（+）细胞。因此，在严重的儿童AD中，CsA微乳。当以低剂量（2.5 mg/kg/天）开始时，可改善疾病的临床指标，减少T淋巴细胞细胞因子的产生，并调节T细胞活化。
Cyclosporin A (CsA) is an effective and well-tolerated treatment for severe childhood atopic dermatitis (AD). By starting at a low dose, the therapeutic safety should be further increased. The aim of this study was to evaluate low-dose CsA in childhood AD with respect to clinical outcome and modulation of T-cell dysregulation. In an open prospective study, 10 children (age: 22-106 months) with severe AD (mean objective SCORAD score > 40 on two baseline measurements at a minimum interval of 2 weeks) were treated with CsA solution for 8 weeks. All patients received a starting dose of 2.5 mg/kg/day, which was increased stepwise in non-responders to a maximum of dose of 5 mg/kg/day. Disease activity was monitored using the SCORAD index. The frequency of cytokine-producing peripheral blood T lymphocytes was analyzed by intracellular cytokine staining, and T-cell numbers were measured by fluorescence-activated cell sorter (FACS) analysis. Twenty healthy age-matched children were included as controls for the immunological data. Nine of the 10 patients had a SCORAD reduction of at least 35%. In seven patients this was achieved with low-dose CsA at 2.5 mg/kg/dav (n = 4) and 3.5 mg kg/day (n = 3). Seven of the nine responders experienced no relapse within the 4-week follow-up period. At baseline the percentage of interleukin-4 (IL-4), IL-13, and human leucocyte antigen (HLA)-DR-positive CD3(+) cells was higher in the patient group than in the controls. After CsA treatment there was a significant reduction in interferon-gamma (IFN-gamma), IL-2, IL-4, IL-13. and HLA-DR-positive CD3(+) cells. Hence, in severe pediatric AD, CsA microemulsion. when started at a low dose (2.5 mg/kg/day), improves clinical measures of disease, reduces T-lymphocyte cytokine production, and regulates T-cell activation.