目的 观察白芍总苷联合甲氨蝶呤治疗重度寻常型银屑病的临床疗效及安全性。方法 选取2012年3月-2015年12月荆州市中心医院皮肤科收治的重度寻常型银屑病患者96例，随机分为对照组和治疗组，每组各48例。对照组口服甲氨蝶呤片，2.5 mg/次，间隔12 h，3次/周。治疗组在对照组基础上口服白芍总苷胶囊，0.6 g/次，3次/d。两组患者连续治疗12周。观察两组的临床疗效，比较两组治疗前后严重性指数（PASI）评分、TNF-α、IL-18及不良反应发生情况。结果 治疗后，对照组和治疗组的总有效率分别为68.75%、91.67%，两组比较差异有统计学意义（P<0.05）。治疗后，两组患者PASI评分均较治疗前显著下降，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗组PASI评分的下降程度明显优于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组的血清TNF-α及IL-18水平均明显降低，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗组这些观察指标的下降程度明显优于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，对照组和治疗组的不良反应发生率分别为29.16%、14.58%，两组比较差异有统计学意义（P<0.05）。结论 白芍总苷联合甲氨蝶呤治疗重症寻常型银屑病有较好的临床疗效，可降低TNF-α及IL-18水平，减少药物不良反应，具有一定的临床推广应用价值。

Objective To observe the clinical effect and safty of total glucosides of paeony combined with methotrexate in treatment of severe psoriasis vulgaris. Methods Patients (96 cases) with severe psoriasis vulgaris in Department of Dermatology, Jingzhou Central Hospital from March 2012 to December 2015 were randomly divided into the control and treatment groups, and each group had 48 cases. Patients in the control group were po administered with Methotrexate Tablets, 2.5 mg/time, interval 12 h, three time weekly. Patients in the treatment group were po administered with Total Glucosides of White Paeony Capsules on the basis of the control group, 0.3 g/time, three times daily. After treatment, the clinical efficacies were evaluated, and PASI, TNF-α, IL-18, and adverse reactions in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 68.75% and 91.67%, respectively, and there was difference between two groups (P<0.05). After treatment, the PASI scores in two groups were significant decreased, and the difference was statistically significant in the same group (P<0.05). And the PASI scores in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, TNF-α and IL-18 in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, the incidence of adverse reactions in the control and treatment groups were 29.16% and 14.5%, respectively, and there was difference between two groups (P<0.05). Conclusion Total glucosides of paeony combined with methotrexate have clinical curative effect in treatment of severe psoriasis vulgaris, and can reduce the levels of TNF-α and IL-18, reduce drug adverse reactions, which has a certain clinical application value.