| Abstract | CILJ ISTRAŽIVANJA:
Usporediti terapijski ishod akutne urtikarije liječene kortikosteroidima unutar 48 sati i nakon
48 sati od početka bolesti. Očekuje se brži terapijski ishod u bolesnika liječenim
kortikosteroidima unutar 48 sati.
USTROJ ISTRAŽIVANJA:
Provedena je prospektivna studija u trajanju od 6 mjeseci. Glavni uključujući kriteriji bili su
pozitivni simptomi urtikarije (urtika, svrbež, angioedem) i dob između 18 i 65 godina.
Metode koje smo koristili da bismo potvrdili ili isključili dijagnozu urtikarije bile su: detaljna
anamneza, dermatološki status i laboratorijski nalazi. Bolesnici uključeni u istraživanje
podučeni su da vode dnevnik urtikarije i sami bilježe svoje simptome bolesti (broj urtika,
svrbež i prisutnost angioedema) u odgovarajući upitnik 3 puta dnevno 7., 21. i 42. dana od
početka bolesti. Isto bodovanje korišteno je i pri dolasku na Kliniku prije dobivanja
kortikosteroidne terapije od strane dermatologa. Analizirana je najveća zabilježena
vrijednost određenog parametra dobivena iz upitnika za 7., 21. i 42. dan. Na takav način
praćena je brzina i način regresije simptoma bolesti u obje skupine bolesnika. Usporedbom
rezultata za obje ispitivane skupine istražili smo utjecaj tih dviju terapija na tijek i ishod
bolesti.
MJESTO ISTRAŽIVANJA:
Istraživanje je provedeno u Klinici za kožne i spolne bolesti, Kliničkog bolničkog centra Split,
Split, Hrvatska.
SUDIONICI:
Istraživanjem je obuhvaćeno 29 bolesnika koji su se javili u dermatološku ambulantu od
siječnja do lipnja 2011. godine sa dijagnozom urtikarijske bolesti i kojima je indicirana primjena parenteralne kortikosteroidne terapije. Istraživanje je uključilo 19 žena i 10
muškaraca.
GLAVNE MJERE ISHODA:
Usporedili smo terapijski ishod i brzinu promjena kliničkog nalaza u akutnoj urtikariji, između
dvije skupine bolesnika, onih koji su liječeni kortikosteroidima unutar 48 sati i nakon 48 sati
prema vrijednostima dobivenim iz za to posebno strukturiranog upitnika. Analizirali smo broj
urtika, svrbež i prisutnost angioedema 7., 21. i 42. dana od početka bolesti. Broj urtika
stupnjevan je brojem od nula do tri pri čemu nula označava da nema urtika, jedan da je broj
urtika manji od 6, dva da je broj urtika između 6 i 12,a tri da je broj urtika veći od 12. Kod
svrbeža nula označava da nemamo svrbeža, jedan da je svrbež blagi, dva da je svrbež srednje
jak i tri je jak svrbež. U praćenja angioedema nula označava da angioedema nema i jedan
označava prisutnost angioedema.
REZULTATI:
U skupini bolesnika koji su primili kortikosteroidnu terapiju unutar 48 sati smo imali 4 puta
više bolesnika kojima se broj urtika smanjio nakon 7 dana u odnosu na bolesnike koji su
kortikosteroide dobili nakon 48 sati od početka bolesti (P<0,01). Nakon 21 i 42 dan od
početka bolesti nismo dokazali statistički značajnu povezanost u smanjenju broja urtika s
vremenom početka uzimanja terapije. Među bolesnicima liječenim kortikosteroidima imali
smo 7 dan od početka bolesti za 4,5 puta više bolesnika u kojih je došlo do nestajanja urtika
u odnosu na bolesnike liječene istom terapijom nakon 48 sati (P=0,008). Nakon 21 dan od
početka bolesti 1,7 puta više je bilo bolesnika bez urtika među bolesnicima liječenim unutar
48 sati (P=0,050). Nismo dokazali statistički značajnu razliku u broju bolesnika kod kojih je
došlo nestajanja urtika s vremenom početka uzimanja terapije nakon 42 dana od početka
bolesti (P=0,651). U skupini bolesnika koji su primili kortikosteroidnu terapiju unutar prvih 48
sati 5 puta je više bilo bolesnika kojima je nestao svrbež nakon 7 dana od početka bolesti u
odnosu na bolesnike koji su terapiju primili nakon 48 sati (P=0,002). Nakon 21 dan od
početka bolesti 2 puta je više bilo bolesnika kojima je nestao svrbež unutar skupine liječene kortikosteroidima unutar 48 sati u odnosu na skupinu koja je liječena nakon 48 sati
(P=0,021). Nismo dokazali statistički značajnu razliku u broju bolesnika kojima je nestao
svrbež s vremenom početka uzimanja terapije nakon 42 dana od početka bolesti (P=0,651).
Nismo dokazali statistički značajnu razliku u smanjenju stupnja svrbeža s vremenom početka
uzimanja kortikosteroidne terapije nakon 7 dana od početka bolesti (P=0,128), 21 dana od
početka bolesti (P=1,0) ni nakon 42 dana od početka bolesti (P=1). Kod bolesnika koji su
primili kortikosteroidnu terapiju unutar 48 sati 21 dan od početka bolesti svi su bolesnici bez
angioedema. Bolesnici koji su primili kortikosteroidnu terapiju nakon 48 sati ostali su bez
angioedema nakon 42 dana. Po pitanju kroniciteta bolesti nismo dokazali statističku
značajnu povezanost s vremenom uzimanja kortikosteroida zbog premalog uzorka ispitanika
(P=0,651).
ZAKLJUČAK:
Primjena kortikosteroidne terapije unutar 48 sati učinkovitija je i brže dovodi do povlačenja
simptoma bolesti u odnosu na primjenu iste terapije nakon 48 sati. |
| Abstract (english) | OBJECTIVE:
To compare the therapeutic outcome of acute urticaria treated with corticosteroids within
48 hours and after 48 hours since the beginning of illness. Faster therapeutic outcome is
expected with patients treated with corticosteroids within 48 hours.
DESIGN:
A prospective study was made in 6 months time period. Main including criteria were positive
symptoms of urticaria (wheals, itching, angioedema) and age between 18 and 65. Methods
used to confirm or exclude the urticaria diagnosis were: detailed anamnesis, dermatological
status and laboratory results. Patients included in the research were taught to lead the
urticaria journal and note their own symptoms of illness (number of wheals, itching and
presence of angioedema) into an appropriate questionnaire 3 times a day, 7, 21 and 42 days
since the beginning of illness. Same model was applied upon the arrival to the Clinic, before
the dermatologist administered the corticosteroid therapy. Highest noted values of certain
parameters obtained from the questionnaire for 7, 21 and 42 days, were subjected to
analysis. In doing so, it was possible to monitor the rate and the way of symptoms regression
with both groups of patients. By comparing the results of both groups we investigated the
effect of these two therapies on development and the outcome of illness.
SEETINGS:
The research was conducted at the Clinic for skin and venereal diseases of Clinical Hospital
Centre Split in Split, Croatia.
PARTICIPANTS:
The research involved 29 patients who checked into the dermatologic department infirmary
in time span from January to June of 2011, with the diagnosis of urticaria and designated
application of parenteral corticosteroid therapy. 19 women and 10 men were included in the
research.
MAIN OUTCOME MEASURES:
We compared the therapeutic outcome and the rate of change of clinical results with acute
urticaria, between two groups of patients: those who were treated with corticosteroids
within 48 hours and after 48 hours, based on the values obtained from the appropriately
structured questionnaire. We analyzed the number of wheals, itching and the presence of
angioedema on 7, 21 and 42 days since the beginning of illness. The number of wheals was
graded with values from 0 to 3, with 0 meaning that there are none, 1 that the number is
less then 6, 2 that the number is between 6 and 12 and 3 that the number is over 12. With
itching, 0 meant that there is none, 1 that the itching is mild, 2 that it is medium and 3 that it
is severe. With monitoring angioedema, 0 meant that it is not present and 1 that it is.
RESULTS:
In the group of patients who received the corticosteroid therapy within 48 hours, there were
four time more patients whose number of wheals decreased after seven days, in comparison
to the patients who got the corticosteroids after 48 hours since the beginning of illness
(P<0.01). After 21 and 42 days, we were unable to prove a statistically relevant connection
between the decrease in number of wheals and the time the application of therapy started.
Among patients treated with corticosteroids after 7 days since the beginning of illness, there
were 4.5 times more patients who experienced the disappearance of wheals (treated within
48 hours) in comparison to those treated after 48 hours (P=0.008). After 21 days, there were
1.7 times more patients without wheals among those treated within 48 hours (P=0.050). We
were unable to prove statistically relevant connection in the number of patients with the
disappearance of wheals and the time the application of therapy started after 42 days since the beginning of illness (P=0.651). In the group of patients who got the corticosteroid
therapy within 48 hours, there were 5 times more patients whose itching was gone after 7
days, in comparison to those who got the therapy after 48 hours (P=0.002). After 21 days
there were 2 times more patients whose itching disappeared in the group that got the
corticosteroid treatment within 48 hours, in comparison to the group that was treated after
48 hours (P=0.021). We were unable to prove statistically relevant connection in the number
of patients whose itching disappeared and the time the application of therapy started after
42 days since the beginning of illness. We were also unable to prove statistically relevant
connection in the decrease of severity of itching and the time the application of therapy
started after 7 (P=0.128), 21 (P=1.0) or 42 days since the beginning of illness (P=1). Patients
who received the corticosteroid therapy within 48 hours were all without angioedema after
21 days. Patients who received the corticosteroid therapy after 48 hours were without
angioedema after 42 days. Regarding the chronicity of illness, we were unable to prove
statistically relevant connection with the time of administering corticosteroids because of
insufficient number of examinees (P=0.651).
CONCLUSION:
Application of corticosteroid therapy within 48 hours is more efficient and leads to quicker
regression of symptoms of illness then the application of the same therapy after 48 hours. |
