Практическиерекомендации

1. ВсебольныеПНП(15%)являютсястероидрезистентными,поэтомуубольныхИАПнеобходимопроводить онкопоискразвгод;

2. Приразвитиистероиднойрезистентностиазатиопринрекомендуетсяназначатьнаоснованииразработанногопоэтапногоалгоритма:максимальнуюдозуСГКна2-3неделии150мгазатиопринавтечение1,5месяцев.Затемпридостиженииположительногоэффектана80-90%(возможносохранениеединичныхэрозийнаслизистыхоболочкахвстадииэпителизациии1-2корочекнаволосистойчастиголовы)дозуазатиопринарекомендуетсяснижатьдо100мгвсуткиидо50мгвсуткипослесниженияСГКдо20мгвсутки.Через2-3месяцанафонесниженияСГКпосхемемедленногоснижениямалыхдозсуточнуюдозуазатиопринаназначатьчерездень,затеми2разавнеделю.Влетнеевремяприменятьазатиопринежедневновдозенеменее50мгвсутки;

3. БольнымспониженнойэкспрессиеймРНКα-изоформыГР,укоторыхобостренияпротекалибезгенерализациивысыпаний,аотмечалисьлишьединичныепузырииэрозииазатиопринрекомендуетсяназначатькурсами;пациентамсповышеннойэкспрессиеймРНКβ-изоформыГРисниженнымколичествоммембранныхрецепторов,укоторыхнаблюдаетсяупорноетечениекожногопроцессасгенерализациейвысыпанийприобострениях,терапиюподдерживающейдозойазатиоприна(50мг/сут)следуетпроводитьдлительно.

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