中华皮肤科杂志 ›› 2011, Vol. 44 ›› Issue (10): 742-742.

• 临床经验 • 上一篇    下一篇

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白联合治疗泛发性连续性肢端皮炎一例

聂本勇1,邹佳楠1,2,王海燕1,2,张益新1,2,刘翠杰1   

  1. 1. 济南军区总医院皮肤科
    2.
  • 收稿日期:2010-12-21 修回日期:2011-05-26 出版日期:2011-10-15 发布日期:2011-09-30
  • 通讯作者: 聂本勇 E-mail:niexiny@sina.com

Treatment of acrodermatitis continua with recombinant human type II tumor necrosis factor receptor-antibody Fc fusion protein (rhTNFR:Fc): a case report

  • Received:2010-12-21 Revised:2011-05-26 Online:2011-10-15 Published:2011-09-30
  • Contact: Ben-yong Nie E-mail:niexiny@sina.com

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摘要：

患者，男性，16岁，右手指甲周皮肤起红斑、脓疱9年，右手第4和5指指节间关节畸形1年入院。皮肤科检查：右手掌背及第1、4和5指弥漫性红斑，表面散在或密集米粒大小脓疱，部分形成脓湖或脓痂，指甲脱失，手指末端变细；第4、5指指节间关节屈曲畸形，功能受限。四肢皮肤见散在分布少数浸润性红斑，表面有少量小脓疱。患者家族中无银屑病史及类似疾病史。实验室检查：血常规：WBC 7.77×109/L、中性粒细胞百分比57.6%、淋巴细胞百分比30.28%、RBC 4.75×1012/L、HGB 136g/L、PLT 278×109/L。肝功能检查：ALT 13 U/L、AST 17 U/L、ASP 160 U/L、γ-GT 17 U/L、TBIL 19.2 umol/L。抗核抗体(-)、抗dsDNA抗体（-）。梅毒螺旋体特异抗体和艾滋病抗体检测阴性。Hbs-Ag（-），HCV-cAg（-）。脓疱细菌培养无细菌生长。结核菌素纯蛋白衍化物(PPD)试验（+）；胸部X片检查未见明显异常。心电图检查大致正常。诊断：泛发型连续性肢端皮炎。入院后予阿维A胶囊、火把花根片、复方甘草酸苷注射液等联合糠酸莫米松乳膏、莫匹罗星软膏及钙泊三醇倍他米松软膏治疗，经2周治疗皮损部分消退，偶有少量新脓疱形成，受累手指疼痛减轻，但病情仍继续进展，右手第2指和左手第5指亦受累。为遏制病情进一步发展，审慎地权衡利弊后，遂决定开始rhTNFR:Fc治疗。治疗12周后，四肢皮损消退，新脓疱形成停止，但手指畸形和功能无改善，治疗获得部分成功。

关键词: rhTNFR:Fc

Abstract:

The patient, a 16-year-old boy, presented with a 9-year history of periungual erythema and pustules of the right hand as well as one year history of interphalangeal abnormality of the fourth and fifth finger of the right hand. Cutaneous examination revealed diffuse erythema and scattered or dense pustules on the dorsal and palmar aspects of right hand as well as on the first, forth and fifth fingers. Some pustules formed pus lakes or pus scabs. Onychoptosis of the involved fingers with tapering of the distal phalanges was observed. The interphalangeal abnormality of the fourth and fifth finger induced functional limitation. A small amount of infiltrated erythema scattered on the extremities with few pustules on the surface. The patient had no personal or family history of psoriasis. Laboratory examination was in the range of normal reference values, including complete blood count, urinalysis, liver function test, hepatitis B and C serology, antinuclear antibody , anti-dsDNA antibody, and AIDS antibody et al. Purified protein derivative (PPD) of tuberculin test was negative. There were no abnormality in chest X-ray and electrocardiogram examination. The diagnosis of generalized acrodermatitis continua was made. The patient was treated with acitretin capsules, huo ba hua gen tablets, compound glycyrrhizin injection in combination with mometasone furoate cream, mupirocin ointment, and calcipotriol/betamethasone ointment. After 2 weeks of treatment, cutaneous lesions partially subsided, a few of new pustule formed occasionally, and pains of the involved fingers alleviated, but the patients’ disease remained to progress, the second finger of the right hand and the fifth finger of the left hand was also involved. In order to prevent the further development of the disease, then decided to start recombinant human tumor necrosis factor receptor Ⅱ:Fc fusion protein(rhTNFR:Fc, with a trade name of Yisaipu) treatment after weighing the benefit-risk carefully. After 12 weeks of treatment, skin lesions on the extremities subsided, the formation of new pustules stopped, but the finger deformity and function did not improve.

Key words: rhTNFR: Fc