【摘要】：背景白癜風是一種色素脫失疾病,NB-UVB治療白癜風療效好、副作用小、操作簡單而被廣泛應用。在既往的研究中顯示NB-UVB治療白癜風與多種因素有關,如:分型、部位、年齡、膚色、病程等,目前研究表明細胞因子和趨化因子與白癜風的發(fā)病和治療療效有關。雖然NB-UVB治療白癜風獲得較好的療效,但是部分穩(wěn)定期白癜風患者治療效果差,具體原因未見相關報道;NB-UVB治療白癜風一段時間后療效停止,出現(xiàn)平臺期,平臺期出現(xiàn)的早晚與復色出現(xiàn)的早晚、療效是否有關未見相關報道;光療一段時間后白斑處會出現(xiàn)光不敏感現(xiàn)象,停止光療后多久白斑恢復到最初治療時的光敏感度未見相關報道。本研究就這幾個問題作出探索。目的觀察NB-UVB治療白癜風平臺期出現(xiàn)時光療次數(shù)、初次復色時光療次數(shù)、療效三者之間的關系;停止光療后多久,白斑恢復到最初治療時光敏感度所需時間;篩查光療效差者白斑處皰液中部分細胞因子及趨化因子水平較效優(yōu)者差異,初步探索光療效差者可能存在的原因。方法選取符合本研究要求的患者66名,以拍照的方式記錄光療期間患者的復色情況,比較有效和無效的患者初次復色時光療次數(shù)、有效復色期間光療總次數(shù)、平臺期出現(xiàn)時光療次數(shù)間的差異;進入平臺期后以患者白斑處初始最小紅斑量對剩余白斑定期進行2cm×2cm面積的照射,出現(xiàn)淡紅斑時則認為光耐受結束,記錄光耐受結束的時間;選取完成一個療程光療且復色小于10%和大于75%的患者各十名,以負壓吸皰的方式收集白斑處皰液,用Luminex檢測皰液中GM-CSF、IL-4、IL-6、IL-10、TNF-α、INF-γ、IP-10的水平。結果初次復色出現(xiàn)在第9次光療前患者療優(yōu)于9次(包括9次)后的患者(P0.05);有效復色期間光療總次數(shù)17次的患者療效優(yōu)于≤17次的患者(P0.05);平臺期出現(xiàn)在第25次光療前的患者與第25次(包括25次)光療后的患者療效比較,差異無統(tǒng)計學意義(P0.05);光耐受白斑恢復光敏感所需要的時間集中在45-75天之間;光療效優(yōu)者對比效差者白斑處TNF-α、IFN-γ、IL-10、IP-10水平有差異。結論1.NB-UVB治療白癜風初次復色出現(xiàn)在9次前的患者,有效復色期間光療總次數(shù)多,療效好。2.光療到一定次數(shù)后平臺期均會出現(xiàn),平臺期與初次復色出現(xiàn)的早晚、療效的好壞無關。3.進入平臺期停止光療后臨床上建議至少休息75天再進行下一個療程光療,以期在小的累積能量下進行有效治療。4.IL-10、TNF-α、IFN-γ水平可能與光療治療白癜風療效有關。
[Abstract]:Background Vitiligo is a pigment loss disease. NB-UVB is widely used in the treatment of vitiligo. Previous studies have shown that NB-UVB treatment of vitiligo is related to a variety of factors, such as typing, location, age, skin color, course of disease and so on. Current studies have shown that cytokines and chemokines are associated with the pathogenesis and therapeutic efficacy of vitiligo. Although NB-UVB is effective in the treatment of vitiligo, the treatment effect of some stable vitiligo patients is poor. There is no related report that the curative effect of NB-UVB on vitiligo stopped after a period of time, and the stage of vitiligo appeared. There is no report on whether the therapeutic effect is related to the occurrence of the terrace in the morning and evening, and the light insensitivity will appear in the white spot after phototherapy for a period of time. How long the white spot returned to the initial treatment after stopping phototherapy was not reported. This study explores these issues. Objective to observe the relationship between the number of times of phototherapy in the plateau stage of NB-UVB treatment of vitiligo, the number of times of phototherapy in the first time of phototherapy, and the time required to recover the sensitivity of the initial treatment time after stopping phototherapy. The levels of some cytokines and chemokines in the leucoplast fluid of the patients with poor light effect were different, and the possible reasons for the poor light effect were explored. Methods Sixty-six patients who met the requirements of this study were selected to record the photochromic status of the patients during phototherapy by taking pictures. The effective and ineffective patients were treated with phototherapy for the first time and the total times of phototherapy during the effective phototherapy. After entering the platform stage, the residual white spot was irradiated with the initial minimum erythema at the white spot of the patient by 2cm 脳 2cm area, and the light tolerance was considered to be over and the time of the end of the light tolerance was recorded when the light erythema appeared. Ten patients with phototherapy less than 10% and more than 75% were selected for a course of phototherapy. The blister fluid of white spot was collected by suction blister under negative pressure, and the level of GM-CSF,IL-4,IL-6,IL-10,TNF- 偽 -INF- 緯 IP-10 in blister fluid was detected by Luminex. Results the primary phototherapy was better than 9 times (including 9 times) before the ninth phototherapy (P0.05), the curative effect of the patients with 17 times of phototherapy was better than that of 鈮，

本文編號：2231125