他克莫司软膏联合308 nm准分子激光治疗白癜风临床疗效观察

目的：评价0．1％和0．03％他克莫司软膏联合308nm准分子激光治疗对紫外线治疗抵抗的白癜风皮损的疗效与安全性。方法：采用随机、自身对照的临床试验，每例患者选取紫外线治疗抵抗区域的皮损，随机选取躯体一侧皮损为治疗侧，采用他克莫司软膏联合308nm准分子激光治疗；另一侧为对照侧，仅用308nm准分子激光治疗。2个月后进行疗效判定。结果：联合治疗组有效率为89．0％，对照组为71．6％，两组间疗效比较差异有统计学意义（P〈0．05）。结论：他克莫司软膏联合308nm准分子激光治疗白癜风起效快，疗效好。     

Narrow-band ultraviolet-B stimulates proliferation and migration of cultured melanocytes

Narrow-band ultraviolet-B (UVB) radiation is an effective treatment for vitiligo vulgaris. However, the mechanisms of narrow-band UVB in inducing repigmentation of vitiligo lesions are not thoroughly clarified. The purpose of our study was to investigate the effects of narrow-band UVB irradiation on melanocyte proliferation and migration in vitro. Our results showed that the cell counts as well as [3H]thymidine uptake of melanocytes were significantly enhanced by narrow-band UVB-irradiated keratinocyte supernatants. In these supernatants, a significant increase in basic fibroblast growth factor (bFGF) and in endothelin-1 (ET-1) release was observed. bFGF is a natural mitogen for melanocytes, whereas ET-1 can stimulate DNA synthesis in melanocytes. This stimulatory effect of melanocyte proliferation by supernatants derived from narrow-band UVB-irradiated keratinocytes was significantly reduced by a selective endothelin-B (ET-B) receptor antagonist (BQ788), suggesting an essential role of ET-1 on melanocyte proliferation. Our results of time-lapse microphotography revealed a stimulatory effect of narrow-band UVB irradiation on melanocyte migration. Focal adhesion kinase (FAK) plays a pivotal role in cell migration. Phosphorylated FAK (p125(FAK)) expression on melanocyte was enhanced by narrow-band UVB irradiation. In this study, narrow-band UVB irradiation stimulated a significant increase in matrix metalloproteinase-2 (MMP-2) activity in melanocyte supernatants. Narrow-band UVB-irradiation-induced migration of melanocytes was significantly annihilated by the addition of p125(FAK) inhibitor (herbimycin-A) or MMP-2 inhibitor (GM6001). These results suggest that p125(FAK) and MMP-2 activity play important roles in narrow-band UVB-induced migration of melanocytes. Our results provide a theoretical basis for the effectiveness of narrow-band UVB irradiation in treating vitiligo.     

白癜风皮损黑素细胞HMB-45、酪氨酸酶及其相关蛋白1的免疫组化研究

目的:研究白癜风白斑处黑素细胞分布及酪氨酸酶(TYR)等标记分子的表达情况。方法:对吸疱法所取白斑皮肤以免疫组化染色识别TYR、酪氨酸酶相关蛋白1(TRP1)和HMB-45,以Mias99彩色图像分析软件定量图像分析阳性表达的强弱。结果:白斑处黑素细胞数目明显低于正常对照(P<0.01),患者非皮损处与正常人皮肤比较差异无显著性(P>0.05)。皮损处黑素细胞树突减少,平均为3.4个,低于对照组(P<0.05)。残留黑素细胞各抗体呈强阳性染色。白斑毛囊之间可见黑素细胞散在、呈围管样分布。白斑处阳性细胞HMB-45图像灰度值低于正常着色皮肤(P<0.05),而TRP1高于正常皮肤(P<0.01),TYR与正常皮肤无差异(P>0.05)。结论:白斑处仍然有黑素细胞。残存黑素细胞树突回缩、数目变少,而且黑素细胞中黑素细胞标记分子表达异常。     

Effect of topical calcipotriol, betamethasone dipropionate and their combination in the treatment of localized vitiligo

BACKGROUND: Treatment of vitiligo is a challenge. Steroids are known to be effective but are associated with serious adverse effects. Many uncontrolled studies have shown calcipotriol to be a promising therapeutic modality in vitiligo. OBJECTIVE: To conduct a randomized trial to evaluate the effect of topical calcipotriol ointment (0.005%) and betamethasone dipropionate (0.05%) cream, given alone or in combination, in treatment of localized vitiligo. METHODS: Forty-nine patients with vitiligo affecting 5% of their skin were recruited. Patients were randomized into three groups. Group I patients were treated with betamethasone dipropionate (0.05%) cream twice daily. Group II patients were treated with calcipotriol ointment (0.005%) twice daily, and group III with betamethasone dipropionate (0.05%) in the morning and calcipotriol (0.005%) in the evening. RESULTS: Forty-five patients completed the study period of 3 months with 15 patients in each group. No patient achieved excellent (> 75%) pigmentation. Marked (50% to 75%) repigmentation was observed in 2 (13.3%), 1 (6.7%) and 4 (26.7%) patients in groups I, II and III, respectively. Moderate (25-50%) repigmentation was observed in 7 (46.7%), 5 (33.3%) and 7 (46.7%) patients in groups I, II and III, respectively. Patients with < 25% pigmentation were termed as minimal pigmentation or no response. The mean time for initial pigmentation to appear was 9.04 +/- 2.0 weeks in group I, 10.18 +/- 1.6 weeks in group II and 5.17 +/- 2.4 weeks in group III (P < 0.01). The acquired pigmentation in the lesions was more stable in group III as compared with patients in groups II and I (P < 0.01). Side-effects in the form of atrophy and lesional burning sensations were more common in group I when compared with groups II and III (P < 0.05). CONCLUSION: Combined therapy appeared to give a significantly faster onset of repigmentation along with better stability of the achieved pigmentation and with lesser number of side-effects.     

自体表皮与黑素细胞移植治疗白癜风疗效对比

目的:研究和比较自体表皮移植与黑素细胞移植治疗白癜风的临床效果.方法:自体表皮移植采用局部皮肤发疱后直接进行移植;黑素细胞移植是从疱壁七获取黑素细胞、纯黑素细胞培养与增殖、移植区刮除种植法进行自体黑素细胞移植治疗.结果:自体表皮移植与黑素细胞移植治疗白癜风对其皮损的评分分别为(7.97±2.36)分和(11.46±2.57)分,经统计学分析差异有统计学意义(P＜0.01).结论:自体表皮移植操作方法较简单,黑素细胞移植可治疗面积大的皮损,而且色素分布均匀,临床效果更好.     

Vitiligo-like leucoderma during photochemotherapy for mycosis fungoides

We describe four patients with mycosis fungoides (MF) in whom depigmentation, and also leucotrichia in one, occurred following the resolution of the eruption during phototherapy (psoralen plus ultraviolet A treatment in three patients, climatotherapy in one). In all cases, the depigmentation was localized to the area of the pre-existing MF lesions. There was no clinically obvious phototoxicity. Biopsy study including S100 staining in all cases, and electron microscopy in one case, demonstrated the total absence of melanocytes, with no evidence of MF. It is suggested that the phototherapy may have activated a cell-mediated immunity leading to destruction of the melanocytes. We recommend that vitiligo-like leucoderma be added to the list of untoward effects of phototherapy in MF.     

T cell subpopulations and IL-2R in vitiligo

Immunological alterations have been implicated in the etiopathogenesis of vitiligo. The aim of this study was to determine peripheral lymphocyte subpopulations and interleukin-2 receptor (IL-2R) in patients with vitiligo. Forty-five vitiligo patients (24 female, 21 male) and 34 healthy controls (11 female, 23 male) were included into the study. Eight (17.8%) of the patients had the segmental type, and 37 (82.2%) had generalized vitiligo. The disease was active in 25 (55.6%) patients; the other 20 (44.4%) patients had static vitiligo. Flow cytometry was used to determine the percentages of total T-lymphocytes, B-lymphocytes, helper/inducer T cells, suppressor/cytotoxic T cells, natural killer (NK) cells, activated T cells and interleukin-2 receptor (IL-2R) with the use of CD3, CD19, CD4, CD8, CD16, HLA-DR and CD25 monoclonal antibodies, respectively. The mean value of helper T cells showed a significant difference (p=0.01) between the two groups with the value being 32.5% in patients and 38.1% in control subjects. CD4/CD8 was significantly lower in vitiligo patients (p=0.04). There was also a statistically significant difference in the mean percentage of activated T cells between vitiligo patients and control subjects (4.7 and 8.1, respectively; p=0.001). No statistically significant differences were found when the values were compared between segmental and generalized vitiligo patients, or between active and static cases. In conclusion, T helper/inducer cells, CD4/CD8 ratio and activated (HLA-DR+) T cells are decreased in vitiligo patients, suggesting a role for changes in cellular immunity.     

进行期白癜风皮损周围黑素细胞的抗原递呈细胞相关表型的测定及其临床意义

目的测定进行期白癜风志愿者的白斑周围外观正常皮肤中黑素细胞的抗原递呈细胞相关表型。方法常规培养黑素细胞,采用流式细胞术测定黑素细胞CD3、CD19、CD20、及抗原递呈细胞相关表型CD1a、CD80、CD83、CD86、ICAM-1、CD40及HLA-DR的表达。结果进行期白癜风组培养黑素细胞抗原递呈细胞相关表型CD80、CD83、CD86、CD40、ICAM-1及HLA-DR表达均比正常对照组高,但CD1a与正常对照组比较差异无显著性(P>0.05)。而且随着黑素细胞培养传代次数增多,以上表型会逐渐减低。结论体外培养的进行期白癜风的黑素细胞可以表达抗原递呈细胞的表型,并可能直接递呈抗原给T细胞,参与白癜风细胞免疫损伤机制。     

中药滋补肝肾方对人黑素细胞株黑素合成的影响

目的通过中药滋补肝肾方对人黑素细胞株细胞增殖、酪氨酸酶活性和黑素含量影响的研究,探讨本方治疗白癜风的作用机制.方法采用4-甲基偶氮唑蓝比色法(MTT法)测定本方对细胞增殖的影响,用酶学方法测定对酪氨酸酶活性的影响,比色法测定中药对黑素含量的影响.结果滋补肝肾方对体外培养的人黑素细胞具有促进细胞增殖、提高黑素含量和酪氨酸酶活性作用.结论本方能促进黑素细胞黑素合成,这可能是其治疗白癜风的作用机理之一.