Tóth G G, van de Meer J B, Jonkman M F
Center for Bullous Skin Diseases, Department of Dermatology, Groningen University Hospital, The Netherlands.
J Eur Acad Dermatol Venereol. 2002 Nov;16(6):607-11. doi: 10.1046/j.1468-3083.2002.00413.x.
Pulse therapy with high-dose glucocorticoids was introduced 20 years ago as a treatment modality for autoimmune disease and transplant rejection. The most popular dermatological indication for pulse therapy is severe pemphigus. We reviewed the sequelae of 14 patients with pemphigus who were treated by pulse therapy. Seven of them reached complete remission, although three of them needed a new pulse course due to disease flare-up. Adverse events were minor and confined to 60% of all patients: temporary facial flushing during pulse administration, sleep disturbances during the first night after pulse administration, and mood changes occurred during the week of pulse therapy. The study showed the possibility of oral instead of an intravenous mute of dexamethasone pulse administration, which makes double-blind placebo-controlled trials ethically feasible. Fifty per cent of the patients reached complete remission. This retrospective study does not allow claims on the steroid-sparing effect.
20年前引入了大剂量糖皮质激素脉冲疗法，作为自身免疫性疾病和移植排斥反应的一种治疗方式。脉冲疗法最常见的皮肤科适应证是严重天疱疮。我们回顾了14例接受脉冲疗法治疗的天疱疮患者的后遗症。其中7例完全缓解，尽管有3例因疾病复发需要重新进行脉冲疗程。不良事件轻微，60%的患者出现：脉冲给药期间短暂面部潮红、脉冲给药后第一晚睡眠障碍以及脉冲治疗期间出现情绪变化。该研究表明了口服而非静脉注射地塞米松脉冲给药的可能性，这使得双盲安慰剂对照试验在伦理上可行。5%的患者完全缓解。这项回顾性研究无法就激素节省效应提出主张。
