Mayser P, Mrowietz U, Arenberger P, Bartak P, Buchvald J, Christophers E, Jablonska S, Salmhofer W, Schill W B, Krämer H J, Schlotzer E, Mayer K, Seeger W, Grimminger F
Department of Dermatology and Andrology, Justus Liebig University Giessen, Germany.
J Am Acad Dermatol. 1998 Apr;38(4):539-47. doi: 10.1016/s0190-9622(98)70114-8.
Profound changes in the metabolism of eicosanoids with increased concentrations of free arachidonic acid (AA) and its proinflammatory metabolites have been observed in psoriatic lesions. Free eicosapentaenoic acid (EPA) may compete with liberated AA and result in an antiinflammatory effect.
Our purpose was to assess the efficacy and safety of intravenously administered fish-oil-derived lipid emulsion on chronic plaque-type psoriasis.
A double-blind, randomized, parallel group study was performed in eight European centers. Eighty-three patients hospitalized for chronic plaque-type psoriasis with a severity score of at least 15 according to the Psoriasis Area and Severity Index (PASI) participated in a 14-day trial. They were randomly allocated to receive daily infusions with either a omega-3 fatty acid-based lipid emulsion (Omegavenous; 200 ml/day with 4.2 gm of both EPA and docosahexaenoic acid (DHA); 43 patients) or a conventional omega-6-lipid emulsion (Lipovenous; EPA+DHA < 0.1 gm/100 ml; 40 patients). The groups were well matched with respect to demographic data and psoriasis-specific medical history. Efficacy of therapy was evaluated by changes in PASI, in an overall assessment of psoriasis by the investigator, and a self-assessment by the patient. In one center neutrophil 4- versus 5-series leukotriene (LT) generation and platelet 2- versus 3- thromboxane generation were investigated and plasma-free fatty acids were determined.
The total PASI score decreased by 11.2 +/- 9.8 in the omega-3 group and by 7.5 +/- 8.8 in the omega-6 group (p = 0.048). In addition, the omega-3 group was superior to the omega-6 group with respect to change in severity of psoriasis per body area, change in overall erythema, overall scaling and overall infiltration, as well as change in overall assessment by the investigator and self-assessment by the patient. Response (defined as decrease in total PASI of at least 50% between admission and last value) was seen in 16 of 43 patients (37%) receiving the omega-3 emulsion and 9 of 40 patients (23%) receiving omega-6 fatty acid-based lipid emulsion. No serious side effects were observed. Within the first few days of omega-3 lipid administration, but not in the omega-6 supplemented patients, a manifold increase in plasma-free EPA concentration, neutrophil leukotriene B5 and platelet thromboxane B3 generation occurred.
Intravenous omega-3-fatty acid administration is effective in the treatment of chronic plaque-type psoriasis. This effect may be related to changes in inflammatory eicosanoid generation.
在银屑病皮损中已观察到类花生酸代谢发生深刻变化，游离花生四烯酸（AA）及其促炎代谢产物浓度增加。游离二十碳五烯酸（EPA）可能与释放的AA竞争，从而产生抗炎作用。
我们的目的是评估静脉注射鱼油衍生的脂质乳剂治疗慢性斑块型银屑病的疗效和安全性。
在八个欧洲中心进行了一项双盲、随机、平行组研究。83例因慢性斑块型银屑病住院、根据银屑病面积和严重程度指数（PASI）严重程度评分至少为15的患者参加了为期14天的试验。他们被随机分配接受每日输注，一组接受基于ω-3脂肪酸的脂质乳剂（Omegavenous；200 ml/天，含4.2 g EPA和二十二碳六烯酸（DHA）；43例患者），另一组接受传统的ω-6脂质乳剂（Lipovenous；EPA+DHA<0.1 g/100 ml；40例患者）。两组在人口统计学数据和银屑病特异性病史方面匹配良好。通过PASI的变化、研究者对银屑病的总体评估以及患者的自我评估来评估治疗效果。在一个中心，研究了中性粒细胞4-与5-系列白三烯（LT）生成以及血小板2-与3-血栓素生成情况，并测定了血浆游离脂肪酸。
ω-3组的PASI总分下降了11.2±9.8，ω-６组下降了7.5±8.8（p = 0.048）。此外，在每个身体部位银屑病严重程度的变化、总体红斑变化、总体鳞屑和总体浸润变化以及研究者的总体评估和患者的自我评估方面，ω-3组均优于ω-6组。接受ω-3乳剂治疗的43例患者中有16例（37%）出现反应（定义为入院时与最后一次测量值之间PASI总分至少降低50%），接受基于ω-6脂肪酸的脂质乳剂治疗的40例患者中有9例（23%）出现反应。未观察到严重副作用。在给予ω-3脂质的最初几天内，血浆游离EPA浓度、中性粒细胞白三烯B5和血小板血栓素B3生成出现了显著增加，但在补充ω-6的患者中未出现这种情况。
静脉注射ω-3脂肪酸对慢性斑块型银屑病有效。这种作用可能与炎性类花生酸生成的变化有关。
