目的 探讨甲氨蝶呤联合度普利尤单抗治疗特应性皮炎的临床疗效。方法 选取2021年3月—2022年3月福建医科大学附属南平第一医院收治的76例特应性皮炎患者，随机分为对照组和治疗组，每组各38例。对照组患者皮下注射度普利尤单抗注射液，首周1次，600 mg/次，然后每2周注射300 mg；治疗组在对照组基础上口服甲氨蝶呤片，5 mg/次，1次/周，然后2次/周，2.5 mg/次，间隔12 h，口服甲氨蝶呤片24 h后口服叶酸10 mg。两组持续治疗16周。观察两组患者临床疗效，比较治疗前后两组患者严重程度指数（EASI）评分、研究者整体（IGA）评分、AD积分指数（SCORAD）评分和皮肤病生活质量指数（DLQI）评分，血清白细胞介素-4（IL-4）、IL-6和γ干扰素（IFN-γ）水平，外周血嗜酸性粒细胞（EOS）和免疫球蛋白E（IgE）水平。结果 治疗后，治疗组总有效率明显高于对照组（97.37% vs 81.58%，P＜0.05）。治疗后，两组EASI评分、IGA评分、SCORAD评分和DLQI评分均明显低于治疗前（P＜0.05），且治疗组评分明显低于对照组（P＜0.05）。治疗后，两组IL-4、IL-6、EOS和IgE水平明显降低，而IFN-γ水平升高（P＜0.05），且治疗组这些指标水平明显好于对照组（P＜0.05）。结论 甲氨蝶呤联合度普利尤单抗治疗特应性皮炎可增强治疗疗效，减轻患者病情，改善炎症相关因子合成，降低EOS、IgE水平，提高患者生活质量。

Objective To investigate the efficacy of methotrexate combined with dupilumab in treatment of atopic dermatitis. Methods Patients (76 cases) with atopic dermatitis in the Nanping First Affiliated Hospital of Fujian Medical University from March 2021 to March 2022 were randomly divided into control and treatment group, and each group had 38 cases. Patients in the control group were subcutaneous injection administered with Dupilumab Injection, once for the first week, 600 mg/time, then 300 mg every two weeks. Patients in the treatment group were po administered with Methotrexate Tablets on the basis of the control group, 5 mg/time for the first week, then twice weekly, 2.5mg/time every 12 h, and they were administered with 10 mg folic acid after 24 h of Methotrexate Tablets. Patients in two groups were treated for 16 weeks. After treatment, the clinical evaluation was evaluated, and the scores of EASI, IGA, SCORAD and DLQI, the levels of IL-4, IL-6, IFN-γ, EOS and IgE in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was significantly higher than that of the control group (97.37% vs 81.58%, P < 0.05). After treatment, the scores of EASI, IGA, SCORAD and DLQI in two groups were significantly lower than those before treatment (P < 0.05), and the scores in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the levels of IL-4, IL-6, EOS and IgE were significantly decreased, while the level of IFN- γ were significantly increased in two groups (P < 0.05), and the level of these indexes in the treatment group was significantly better than that in the control group (P < 0.05). Conclusion Methotrexate combined with dupilumab in treatment of atopic dermatitis can enhance the therapeutic effect, alleviate the condition of patients, improve the synthesis of inflammatory related factors, reduce the levels of EOS and IgE, and improve the quality of life of patients.

R986