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1.
随着异基因造血干细胞移植术(allogeneic haematopoietic stem cell transplantation,AHSCT)的发展,患者的生存时间延长。慢性移植物抗宿主病(chronic graft-versus-host disease,c GVHD)是AHSCT后常见的并发症,而皮肤是cGVHD最常累及的器官。皮肤cGVHD会影响美观、引起功能障碍甚至威胁生命。该文总结了皮肤cGVHD的治疗,包括局部治疗、光疗、体外光分离置换(extracorporeal photochemotherapy,ECP)以及系统治疗等方法。  相似文献   

2.
目的 观察亚急性皮肤型红斑狼疮(SCLE)的临床特征和中药治疗、中西医结合治疗的效果。方法 对SCLE的临床表现和实验室检查进行分析;所有病例予青凌草方治疗,若皮疹多,合用羟氯喹或少量皮质类固醇。3个月后评价治疗效果。结果 SCLE的光敏感发生率高(57.14%),抗Ro抗体阳性率高(64.29%),而较少合并内脏损害。经3个月治疗,临床缓解率35.71%,显效率28.57%,有效率21.43%,无效率14.29%。结论 SCLE有鲜明的临床特征;青凌草方对SCLE有较好的治疗效果。  相似文献   

3.
目的观察难治性下肢皮肤溃疡的护理方法以及护理效果。方法选择在我院接受下肢皮肤溃疡治疗的患者84例,进行随机分组对比观察。比对组(n=42)患者应用病情监测、换药护理等常规护理干预,探究组(n=42)患者实施综合性护理干预。结果探究组患者病情总缓解率为95.24%,明显高于比对组患者病情总缓解率76.19%,两组差异有统计学意义(P 0.05)。结论难治性下肢皮肤溃疡患者应用综合性护理干预使临床治疗效果得到显著提高。  相似文献   

4.
目的:探讨电刺激对女性慢性盆腔痛疼痛和生活质量包括性生活的治疗效果。方法:选取2014年10月至2015年8月于武汉大学人民医院妇产科就诊的慢性盆腔痛患者124例,接受电刺激治疗,每次30min,每星期2次,共10次。治疗前后行疼痛评分(VAS)、女性性功能指数(FSFI)和世界卫生组织生活质量简表(WHOQOL-BREF)问卷调查。结果:患者分为慢性盆腔炎组、子宫内膜异位症组和盆腔静脉淤血组,电刺激治疗后慢性盆腔炎组37人完全缓解,11人部分缓解,5人无效,完全缓解率、部分缓解率和无效率分别为69.8%、20.8%、9.4%,VAS评分为(2.375±0.479)(P=0.005),FSFI评分较治疗前提高,为(29.500±1.291)(P=0.005)。子宫内膜异位症组32人完全缓解,10人部分缓解,4人无效,完全缓解率、部分缓解率和无效率分别为69.6%、21.7%、8.7%,VAS评分为(2.550±0.420)(P=0.000),FSFI为(26.450±1.256)(P=0.002)。盆腔静脉淤血组13人完全缓解,6人部分缓解,2人无效,完全缓解率、部分缓解率和无效率分别为61.9%、28.6%、9.5%,VAS评分为(2.600±0.365)(P=0.000),FSFI为(27.700±1.447)(P=0.007)。生活质量方面,三组患者在生理领域、心理领域、社会关系领域评分均较治疗前提高,且有统计学意义,但在环境领域方面,盆腔炎症组和子宫内膜异位症组与治疗前相比有所提高,但无统计学意义。结论:电刺激是短期内治疗慢性盆腔痛,提高患者性生活及生活质量较好的方法,其长期疗效尚有待研究。  相似文献   

5.
本文作者对Ⅰ期皮肤黑素瘤170例采用脉冲激光进行治疗,其中男38例,女132例,年龄7~82岁。肿瘤部位:面部71例(41.7%)、头颈部10例(5.9%)、躯干34例(20%)、上肢26例(15.3%)和下肢29例(17.1%)。肿瘤直径在1cm内33例(19.4%)、2cm 94例(55.3%)、大于2.1cm43例(25.3%)。肿瘤形状为扁平型66例(38.8%)和外生型(高出皮肤3~4mm)104例(61.2%)。  相似文献   

6.
高频微针电灼仪治疗24例中重度腋臭患者临床研究   总被引:1,自引:0,他引:1  
目的 评价使用高频微针电灼仪治疗腋臭的安全性及有效性.方法 收集2015年6月至2016年6月,北京协和医院皮肤科就诊的中重度腋臭患者24例,使用高频微针电灼仪(BodyTiteTM)进行单次治疗,治疗前后使用视觉-气味计分量表(VAS)评价腋下气味,生活质量SF-36量表评估健康相关生活质量,取患者腋下皮肤组织行病理学活检.结果 VAS量表评估显示,24例中22例达到并维持≥12周的症状缓解,平均气味评分下降率(VAS%)50% ~ 100%,1例治疗后12周腋臭复发,1例未获得临床缓解.SF-36量表评估显示,治疗前患者在社会功能、情感职能、精神健康领域得分[M(P0~P100)]分别为77.50(62.50~100.00)、66.67(33.30 ~ 100.00)、55.00(48.88 ~ 72.00),治疗后分别升至100.00(62.00 ~ 112.50)、100.00(33.30 ~ 110.00)、68.00 (48.00~ 80.00),治疗前后差异有统计学意义(均P< 0.05).组织病理显示,治疗后22例汗腺导管细胞出现明显变性、坏死,2例出现表皮损伤.安全性方面,1例治疗后出现单侧上肢疼痛,2例出现小面积皮肤烫伤样改变.术后平均恢复时间为7~ 14d.结论 高频微针电灼仪治疗腋臭临床有效率高,有良好的安全性,具有临床应用前景.  相似文献   

7.
湿疹及皮炎     
20120122 特应性皮炎患者ECP、tIgE、sIgE、EOS的检测及意义/赵俊芳(天津市中研院附院),李桂珍,赵宏丽…//中国中西医结合皮肤性病学杂志.-2011,10(4).-228 ~ 229101例患者及40例正常对照者,分别采用ELISA及免疫印迹法检测ECP,tIgE及sIgE水平,传统方法计数外周血EOS.结果:AD患者ECP,tIgE浓度明显高于正常,而EOS计数两组差异无统计学意义;68.3%患者至少对一种变应原呈阳性反应,44.56%患者对2~7种变应原呈阳性反应,正常对照组sIgE全部阴性.认为ECP,tIgE,sIgE和EOS在AD的发病及病情监测中起一定作用.表3参5(阴亚坤)20120123马拉色菌与特应性皮炎发病机制的中西医理论结合/王韵茹(上海复旦大学华山医院),章强强//中国中西医结合皮肤性病学杂志.-2011,10(3).  相似文献   

8.
目的 总结天疱疮发病的临床规律和特点,探寻最佳治疗方案,为科学治疗天疱疮和改善预后提供依据。方法 回顾性分析1994年4月-2011年1月昆明医学院附属二院皮肤科收治的149例天疱疮住院患者的临床资料。结果 男71例,女78例;平均年龄(46.24±13.10)岁。轻症26例,中症58例,重症65例。轻、中和重症天疱疮患者激素治疗初始用量分别为(42.15±11.60)mg,(76.94±25.80mg)和(104.02±14.31)mg(P<0.05);重症患者中激素联合免疫抑制剂组病情缓解率(82.05%,32/39)高于激素组(57.69%,15/26,P<0.05)。结论 天疱疮好发于中年人,无性别差异。口腔/头皮受累常提示病情严重;激素用量根据病情严重程度而定,激素联合免疫抑制剂治疗优于单用激素;感染是其主要并发症;疾病类型、病情严重程度及是否合并低蛋白血症是影响预后的重要因素。  相似文献   

9.
光动力疗法治疗皮肤肿瘤疗效观察   总被引:2,自引:0,他引:2  
目的 观察盐酸氨基酮戊酸光动力疗法(ALA-PDT)治疗皮肤癌前病变和皮肤癌的疗效.方法 对17例光线性角化病、10例基底细胞癌和7例鲍温病患者进行ALA-PDT治疗:20%ALA霜剂涂于皮损;4h后激光照射.能量密度为100~120J/cm2,时间约40 min.结果 随访6~12个月,17例光线性角化病患者皮损获得完全缓解,无复发;10例基底细胞癌患者的皮损,8例获完全缓解.1例获部分缓解,1例无反应,3例平均于治疗后6个月复发;7例鲍温病患者皮损,6例获得完全缓解,1例部分缓解.1例于治疗后8个月复发.结论 ALA-PDT是一种疗效好、无明显痛苦、无瘢痕形成、复发率低、美容效果好的治疗皮肤肿瘤的新疗法.  相似文献   

10.
目的 通过检测血清总IgE(tIgE)、嗜酸细胞阳离子蛋白(ECP),证实痤疮伴颜面皮肤敏感患者皮肤过敏状态的存在,以进一步探讨其机理,指导临床取得更好的疗效。方法 取痤疮伴颜面皮肤弥漫性潮红、毛细血管扩张、散在毛囊性丘疹、丘疱疹或细薄脱屑、遇风、冷、热、日晒等刺激加重患者治疗前血清,使用Pharmacia UniCAP系统进行检测。入选患者予清热利湿、凉血解毒之中药内服,外用以安抚及抗炎为主。结果 55例患者中血清tIgE增高者占69.1%,ECP增高者占83.6%,提示皮肤过敏状态的存在。经用清热利湿、凉血解毒之中药4周后,痤疮显效率为52.8%,皮肤敏感显效率为85.5%。结论 痤疮患者发生皮肤敏感现象,诱因诸多,通过检测血清tIgE、ECP,证实其过敏状态的存在,以利于进一步探讨病机。中药具有降低皮肤敏感性与抗感染双重作用,取得了较满意疗效。  相似文献   

11.
BackgroundExtracorporeal photopheresis (ECP) is an immunomodulatory therapy used to treat graft-vs-host disease (GVHD) in adults and children. Few studies have examined its use in children.ObjectiveTo describe demographic characteristics, clinical response, adverse effects, and outcomes in a series of pediatric patients with acute or chronic GVHD treated with ECP.Material and methodsWe included all pediatric patients with acute or chronic GVHD treated with ECP by the Dermatology Department of Hospital Italiano de Buenos Aires between January 2012 and December 2018. We used the UVAR-XTS™ system (2 patients) and the CELLEX system (7 patients). Patients with acute GVHD received 2 sessions a week and were reassessed at 1 month, while those with chronic GVHD received 2 sessions every 2 weeks and were reassessed at 3 months. Treatment duration in both scenarios varied according to response.ResultsWe evaluated 9 pediatric patients with corticosteroid-refractory, -dependent, and/or -resistant GVHD treated with ECP. Seven responded to treatment and 2 did not. Response was complete in 1 of the 9 patients with skin involvement and partial in 7. Complete response rates for the other sites of involvement were 60% (3/5) for the liver, 50% (1/2) for the gastrointestinal system, and 80% (4/5) for mucous membranes. Two patients died during the study period.ConclusionECP is a good treatment option for pediatric patients with acute or chronic GVHD.  相似文献   

12.
Background Graft‐versus‐host disease (GVHD) represents an important complication following allogeneic bone marrow transplantation. In recent years, narrowband ultraviolet B (NB‐UVB, 311–313 nm) has been found to be a beneficial adjuvant treatment in patients refractory to first‐line immunosuppressive drugs. Objectives The aim of this study is to analyse retrospectively the clinical outcome of 10 GVHD paediatric patients treated with NB‐UVB therapy. Patients and methods Ten paediatric patients (six girls and four boys: median age 12·5 years, range 4–20) with cutaneous GVHD were enrolled in the study: five patients with chronic GVHD and five patients with an overlap syndrome GVHD. All patients had already been shown to be resistant to first‐choice immunosuppressive protocols, and were treated with NB‐UVB phototherapy until a clinical remission of skin lesions occurred. Results A complete response (absence of lesions) was achieved in 80% of the cases (eight patients) after a median number of 29 treatments, corresponding to a median of 7·5 weeks (52 days) of treatment (range 3–13 weeks), with an average cumulative dose of 28·71 J cm?2 (range 1·02–70·38 J cm?2). Only two patients reported a partial remission (< 18% of body surface area involved). During the follow‐up period, a complete remission after 1 year was observed in 75% of patients and after 2 years in 71% of the evaluable patients. Conclusions This study provides evidence that NB‐UVB phototherapy represents a valid second‐line treatment in paediatric patients affected by GVHD and refractory to immunosuppressive first‐line treatment.  相似文献   

13.
BACKGROUND: Cutaneous chronic graft versus host disease (GVHD) is a severe complication following allogeneic stem cell (PBSCT) and bone marrow transplantation (BMT). Immunosuppressive therapy consists of prednisone, cyclosporine-A, azathioprine or mycophenolate mofetil (MMF). Treatment of patients refractory to immunosuppression represents a major problem. METHODS: We report six patients suffering from severe chronic GVHD of the skin who did not respond to immunosuppressive therapy or relapsed after reduction of glucocorticosteroids. Patients were treated with psoralen plus ultraviolet (PUVA)-bath photochemotherapy three times weekly following a standardized treatment protocol under continued treatment with prednisone and/or MMF. One patient was additionally pretreated with ultraviolet-A1 (UV-Al). RESULTS: After a median of 14, 5 treatment sessions, skin lesions improved. Out of six patients, three showed a complete remission. In all patients, systemic immunosuppressive therapy could be reduced. In sclerodermic lesions, skin thickness returned to the levels of normal skin after 25 treatments confirmed by 20 MHz ultrasound evaluation. In a follow-up ranging from 2 to 21 months (median 10, 3 months), skin conditions remained stable. CONCLUSION: Psoralen plus ultraviolet-A-bath represents an effective adjunct treatment option for extensive chronic and sclerodermic cutaneous GVHD offered by dermatologists. This is of high interest in patients suffering from cutaneous GVHD resistant to conventional immunosuppressive therapy and should be included to the menu of topical treatment options for chronic cutaneous GVHD.  相似文献   

14.
15.
BACKGROUND: Case reports have suggested that extracorporeal photochemotherapy (ECP) might be beneficial for the treatment of erosive oral lichen planus (OLP) recalcitrant to conventional immunosuppressive therapies. OBJECTIVES: To evaluate over a long-term period the clinical efficacy and toxicity of ECP in a series of patients with refractory OLP, and to monitor peripheral blood lymphocyte subset counts under treatment. METHODS: Twelve patients with refractory OLP underwent a standardized protocol of ECP. Sessions were performed twice weekly for 3 weeks, and then the treatment schedule was adapted according to clinical benefit. The disease severity was evaluated monthly on a clinical basis. Complete remission was defined as the absence of any erosion and partial remission as a decrease of at least 50% of erosion surface. Blood cell counts with CD4+ and CD8+ lymphocyte subsets were evaluated every 3 months. RESULTS: All patients showed a decrease of the erosive surface; nine (75%) achieved a complete remission and three (25%) a partial remission. Seven of the eight patients followed for more than 3 years had recurrences of erosions when ECP sessions became less frequent or were stopped. After resumption of an initially accelerated regimen of ECP, all again showed partial or complete remission. Blood lymphocyte counts decreased during treatment, without statistically significant changes in CD4+/CD8+ ratio, and increased during relapse. CONCLUSIONS: ECP is an effective alternative therapy in erosive OLP showing resistance to classical treatments. The decrease in blood lymphocyte counts appears to parallel the clinical improvement under treatment.  相似文献   

16.
BACKGROUND: Cytokines derived from T helper (Th)1 lymphocytes are thought to be involved in the pathogenesis of graft-versus-host disease (GVHD) and extracorporeal photopheresis (ECP) has been reported to affect Th1/Th2 lymphocyte ratios. It may also influence the balance of cytotoxic Tcells (Tc1/Tc2). OBJECTIVES: This study was formulated to assess the effect of ECP on the cytokine profiles of peripheral blood (PB) lymphocytes from patients with chronic GVHD. PATIENTS AND METHODS: Nine patients were studied. Peripheral blood was sampled at baseline and between 3 and 4 months of therapy when clinical effects are demonstrable. Intracellular cytokine production was assessed in vitro by stimulating PB lymphocytes with phorbol-12-myristate 13-acetate (PMA), inhibiting cytokine release and staining with fluorescein-labelled monoclonal antibodies to interleukin (IL)-2, interferon gamma (IFN-gamma) and IL-4. Flow cytometry analysis gave the absolute number and the percentage of cells expressing a particular cytokine within each lymphocyte subset. RESULTS: Absolute counts of CD3, CD4, CD8, CD19 and CD16+ cells per microlitre were recorded before and after ECP. There was a small but non-significant reduction in all subsets after 3 months of ECP. The percentage of cells expressing IL-2 and IFN-gamma rose following ECP in both the CD4 and CD8 subsets. However, only the percentage of CD4 cells expressing IFN-gamma reached statistical significance (P = 0.02; 95% confidence interval, CI 0.6-15.6). There were no significant changes in the percentage of CD4 cells expressing IL-4. CONCLUSIONS: Our findings appear to be inconsistent with current theories regarding the pathogenesis of GVHD as increased production of Th1 or Tc1 cytokines might be expected to exacerbate GVHD. However, chronic GVHD is characterized by a relative deficiency of IL-2 and IFN-gamma producing cells compared with other patients post-bone marrow transplantation (BMT). This indicates that Th1 and Tc1 cytokines are depleted in chronic GVHD. Thus, by reducing disease activity, ECP could allow cytokine production by these cells to recover. This indicates that the therapeutic effect of ECP is mediated by a different mechanism, and that the changes observed in this study are epiphenomena.  相似文献   

17.
BACKGROUND: Extracorporeal photochemotherapy (ECP) using UVA irradiation of enriched leukocytes in the presence of methoxsalen as a photoactivatable substrate has been employed for the treatment of several immunologically mediated disorders. OBJECTIVE: Our purpose was to determine the efficacy and safety of long-term ECP in the treatment of severe atopic dermatitis. METHODS: Fourteen patients with severe recalcitrant atopic dermatitis were treated with ECP in an open clinical trial at 2-week intervals. Disease activity was scored before each ECP cycle by means of a standardized protocol. RESULTS: A complete clinical remission was achieved in 4 patients (29%). Five patients (36%) experienced a substantial response with reduction of skin inflammation by at least 75%, whereas in one patient (7%) disease activity was reduced by more than 50%. Four patients were withdrawn from the study for unresponsiveness. No clinical signs of immunosuppression or other severe adverse events became evident. CONCLUSION: Long-term ECP may have significant beneficial effects on the course of atopic dermatitis and should therefore be considered as a treatment modality for patients suffering from severe and otherwise refractory atopic skin disease.  相似文献   

18.
目的 探讨中国红斑狼疮(LE)患者的临床特征.方法 从中国人群LE多中心病例对照研究(LEMCSC)中获得数据,以统一标准纳入样本及收集临床资料.用EpiData 3.1录入数据和SPSS 18.0统计数据.结果 共有1 006例LE患者(女性87.6%)纳入分析,其中系统性红斑狼疮(SLE) 887例(女性89.9%),无内脏系统受累的皮肤型红斑狼疮(CLE) 119例(女性70.6%).SLE患者各系统受累情况是皮肤(72.7%)>关节(69.2%)>血液(60.8%)>肾脏(48.5%)>浆膜(18.2%)>神经系统(5.7%).LE特异性皮损的出现可增加伴发关节炎风险[OR=1.612,95%可信区间(CI)1.181 ~ 2.200],却可降低伴发肾炎和浆膜炎的风险(OR分别为0.218及0.311;95% CI分别为0.157 ~ 0.303及0.218 ~ 0.443).急性皮肤型红斑狼疮皮损的出现是伴发系统受累的危险因素(OR=4.931,95% CI 3.232 ~ 7.524),而慢性皮肤型红斑狼疮皮损的出现却是伴发系统受累的保护因素(OR=0.355,95% CI 0.234 ~ 0.541).LE非特异性皮损的出现与内脏受累密切相关.结论 揭示中国LE患者的基本临床特征以及LE相关皮损与内脏器官受累的关系.  相似文献   

19.
Extracorporeal photopheresis (ECP) is a technique that was developed > 20 years ago to treat erythrodermic cutaneous T-cell lymphoma (CTCL). The technique involves removal of peripheral blood, separation of the buffy coat, and photoactivation with a photosensitizer and ultraviolet A irradiation before re-infusion of cells. More than 1000 patients with CTCL have been treated with ECP, with response rates of 31–100%. ECP has been used in a number of other conditions, most widely in the treatment of chronic graft-versus-host disease (cGvHD) with response rates of 29–100%. ECP has also been used in several other autoimmune diseases including acute GVHD, solid organ transplant rejection and Crohn's disease, with some success. ECP is a relatively safe procedure, and side-effects are typically mild and transient. Severe reactions including vasovagal syncope or infections are uncommon. This is very valuable in conditions for which alternative treatments are highly toxic. The mechanism of action of ECP remains elusive. ECP produces a number of immunological changes and in some patients produces immune homeostasis with resultant clinical improvement. ECP is available in seven centres in the UK. Experts from all these centres formed an Expert Photopheresis Group and published the UK consensus statement for ECP in 2008. All centres consider patients with erythrodermic CTCL and steroid-refractory cGvHD for treatment. The National Institute for Health and Clinical Excellence endorsed the use of ECP for CTCL and suggested a need for expansion while recommending its use in specialist centres. ECP is safe, effective, and improves quality of life in erythrodermic CTCL and cGvHD, and should be more widely available for these patients.  相似文献   

20.
OBJECTIVE: To determine the value of skin biopsies in the management of suspected graft-vs-host disease (GVHD) within 30 days of allogeneic bone marrow transplantation (BMT). DESIGN: Retrospective study based on review of a BMT database. SETTING: Leukemia/BMT ward of a tertiary care, university teaching hospital. PATIENTS: One hundred and eighty-seven consecutive patients who received allogeneic BMT between January 1, 1994, and June 30, 1997, at Vancouver General Hospital, Vancouver, British Columbia. MAIN OUTCOME MEASURES: (1) Skin biopsy frequency for patients with rashes suggestive of acute GVHD; (2) clinical significance of skin biopsy in the management of patients with suspected acute GVHD after BMT; (3) relationship between severity of clinical GVHD and the likelihood to receive GVHD therapy; and (4) relationship between biopsy status or biopsy result and outcome of BMT (acute and chronic GVHD, transplant-related mortality, and overall and event-free survival). RESULTS: During the early post-BMT period (<30 days after BMT), 88 patients had rashes suggestive of acute GVHD; of these, 51 (58%) underwent skin biopsy to confirm the diagnosis. Skin biopsies were performed more often for higher clinical stages of cutaneous GVHD. There was no significant difference between the patients with positive biopsy findings and those with negative findings, either in the clinical severity of acute GVHD or in likelihood to receive treatment for GVHD. Most (85%) of the patients who underwent biopsies and received GVHD therapy had treatment initiated before skin biopsies were performed or before the results were available. The higher the clinical grade of overall acute GVHD, the more likely it was that the patients were treated for GVHD (P<.001). The outcome of BMT was not influenced by the skin biopsy status or biopsy result. CONCLUSIONS: The biopsy findings correlated poorly with the clinical severity of skin rash suggestive of acute GVHD soon after BMT. The decision to treat suspected acute GVHD depended not on skin biopsy findings but rather on clinical severity of acute GVHD. In this regard, skin biopsy has a limited role in the management of patients early after allogeneic BMT.  相似文献   

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