Clinical Study And Safety Observation Of Hibernation-like Therapy For Psoriasis

Objective: To observe the clinical efficacy and safety of hibernation-like therapy for the treatment of psoriasis.Methods: From April 2018 to December 2018,six patients with psoriasis admitted to the Luwan Branch of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine for treatment of their desease were enrolled in this study.Collecting systemic disease history and general information of patients.Before the treatment,the pictures of patients,skin lesions and biopsy samples of skin were collected.At the same time,blood samples were collected to detect blood routine,liver function,renal function,blood viscosity,blood coagulation,related inflammation indicators(including IL-6,IL-17 A,IL-23,TNF-).Hibernation-like therapy is a method of using scopolamine under propofol anesthesia.The specific procedure was that the patients were given 1% propofol for TCI induction under strict ECG monitoring,the initial plasma target concentration was set at 2ug/ml,the dosage of propofol was adjusted according to the Narcotrend value,the total dosage of scopolamine hydrobromide was 0.05mg/kg,which was intravenously injected during anesthesia maintenance,and the treatment was maintained for 6-7 hours.The patients were safely sent back to the ward after waking up.The treatment was performed every 2 weeks,and skin lesions were taken again after admission and blood samples were taken for relevant tests.Relevant data of patients after the last treatment and before the initial treatment were compared and analyzed to evaluate the improvement of psoriasis area and severity index(PASI),observe the clinical efficacy and adverse drug reactions,and analyze the possible mechanism of hibernation-like therapy for psoriasis at the cytokine level.Results: A total of 6 patients were enrolled,aged 18-53 years,with an average age of(35.5±14.1)years.Three patients had a PASI score of more than 25% after treatment,which were 33.3%,48.78%,48.24%,respectively.The PASI score decreased by 17.5% in one patient,decreased slightly 3.33% in another people,and increased 2.41% in a male patient.The last two patients changed their therapy after treatment with hibernation-like therapy for 3 and 2 times respectively.The final average PASI scores of the 6 patients were compared to the pre-treatment PASI scores,and the P value was 0.249,P>0.05,with no statistical difference.The head,upper limbs,trunk,lower limbs were compared with the initial PASI scores,P values were 0.042,0.916,0.345,0.618,respectively.Only the head PASI score after therapy showed statistical difference.The P values of IL-6,IL-17 A,IL-23,TNF-were 0.660,0.759,0.661 and 0.824 respectively,compared with the initial results.P values were all greater than 0.05,so there was no statistical significance.All patients developed dry mouth symptoms after treatment.A few patients developed involuntary limb movement during and after treatment.One patient had postoperative venous pain and improved after discharge.Tongue suffix was considered in 1 patient with inspiratory phase obstruction during treatment.All adverse reactions disappeared the next day after treatment.Conclusion: Hibernation-like therapy can improve the clinical symptoms of patients with psoriasis,and it has a significant effect on the improvement of head lesions.This therapy may provide a new option for the treatment of psoriasis.