目的 觀察白芍總苷聯(lián)合甲氨蝶呤治療重度尋常型銀屑病的臨床療效及安全性。方法 選取2012年3月-2015年12月荊州市中心醫(yī)院皮膚科收治的重度尋常型銀屑病患者96例，隨機分為對照組和治療組，每組各48例。對照組口服甲氨蝶呤片，2.5 mg/次，間隔12 h，3次/周。治療組在對照組基礎(chǔ)上口服白芍總苷膠囊，0.6 g/次，3次/d。兩組患者連續(xù)治療12周。觀察兩組的臨床療效，比較兩組治療前后嚴(yán)重性指數(shù)（PASI）評分、TNF-α、IL-18及不良反應(yīng)發(fā)生情況。結(jié)果 治療后，對照組和治療組的總有效率分別為68.75%、91.67%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組患者PASI評分均較治療前顯著下降，同組治療前后比較差異有統(tǒng)計學(xué)意義（P<0.05）；且治療組PASI評分的下降程度明顯優(yōu)于對照組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組的血清TNF-α及IL-18水平均明顯降低，同組治療前后比較差異有統(tǒng)計學(xué)意義（P<0.05）；且治療組這些觀察指標(biāo)的下降程度明顯優(yōu)于對照組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，對照組和治療組的不良反應(yīng)發(fā)生率分別為29.16%、14.58%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 白芍總苷聯(lián)合甲氨蝶呤治療重癥尋常型銀屑病有較好的臨床療效，可降低TNF-α及IL-18水平，減少藥物不良反應(yīng)，具有一定的臨床推廣應(yīng)用價值。

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.