系统糖皮质激素治疗进展期白癜风的疗效及相关因素研究

目的:探讨系统糖皮质激素（简称激素）治疗白癜风疾病活动度评分（VIDA）≥ 2分的进展期患者的疗效及相关因素。方法:2018年6月至2019年6月于杭州市第三人民医院皮肤科,收集未经系统性激素治疗、VIDA ≥ 2分、皮损面积<1%的进展期白癜风患者272例,分析皮损面积和型别、VIDA评分、是否具有诱发因素及特殊临床...     

他克莫司软膏治疗白癜风疗效和安全性观察

国外已有他克莫司治疗白癜风报告,其结果显示该药治疗白癜风的有效性和安全性[1].本研究采用多中心,开放性研究,以评估其在白癜风患者的有效性和安全性.     

系统应用糖皮质激素治疗白癜风

白癜风是一种常见的色素脱失性皮肤病,发病机制复杂且不完全清楚,治疗方式多样但疗效欠佳。研究表明,系统应用糖皮质激素通过其抗炎、免疫抑制等作用可以控制白癜风的进展、促进皮损复色,其治疗方法包括低剂量每日口服疗法、间歇疗法、冲击疗法,以及联合外用药、光疗、外科治疗等。系统应用糖皮质激素需根据白癜风类型、发展时期选择适宜的治疗方法,才能达到最佳疗效、减少不良反应。     

寻常型进展期白癜风患者外周血T淋巴细胞FasL和TNF-α的表达

目的检测寻常型进展期白癜风患者外周血T淋巴细胞FasL和TNFα的表达。方法随机采集30例寻常型进展期白癜风患者外周血3ml,分离T淋巴细胞后进行细胞涂片,使用免疫组化和原位杂交方法检测FasL和TNFα的蛋白和mRNA水平。并以30例静止期患者(对照组1)和20例健康志愿者(对照组2)作对照。结果与两个对照组相比,实验组FasL和TNFα的表达明显增加(P<0.001)。同时,与对照组2相比,对照组1FasL和TNFα的表达显著升高(P<0.001)。结论寻常型进展期白癜风患者外周血T淋巴细胞FasL和TNFα的表达显著升高。     

糖皮质激素对甲状腺抗体升高的进展期白癜风患者的疗效及抗体水平的影响

目的:探讨糖皮质激素对并发甲状腺抗体升高的进展期白癜风患者血清中甲状腺过氧化物酶抗体(TPOAB)和甲状腺球蛋白抗体(TGAB)的影响及疗效。方法:将并发甲状腺抗体升高的进展期白癜风患者60例患者,分为试验组和对照组,每组各30例,试验组采用复方倍他米松(得宝松)肌内注射,每个月1次,连续3个月;对照组采用局部照射308 nm准分子激光,每周2次,连续3个月,两组患者均外用他克莫司乳膏,每日2次。治疗1个月和3个月后检测血清中TPOAB和TGAB的水平,同时观察两组患者的皮损情况。结果:试验组有效率为70%,对照组有效率为36.7%。试验组中24例(80%)患者皮损由进展变为稳定,对照组患者12例(40%)皮损稳定。3个月后,试验组患者血清中TPOAB和TGAB的水平均降低,与治疗前相比,差异具有统计学意义,而对照组患者TPOAB和TGAB的水平变化差异无统计学意义。结论:并发甲状腺抗体升高的进展期白癜风,糖皮质激素的疗效优于308 nm准分子激光,且糖皮质激素可以降低患者血清中TPOAB和TGAB的水平。     

巴瑞替尼治疗进展期白癜风疗效分析

目的:评价巴瑞替尼治疗白癜风的疗效及安全性。方法:收集2021年4月至2022年3月因系统用糖皮质激素治疗无效或拒绝使用糖皮质激素而接受巴瑞替尼治疗的病例,在第3、6个月评价其疗效。结果:共收集患者8例,经过3、6个月治疗后,显效率分别为35.3%、55.9%,总有效率分别为67.6%、73.5%。治疗6个月的患者,肢端的疗效低于躯干(总有效率χ²=7.369,P<0.01)和四肢(总有效率χ²=4.554,P<0.05)的疗效。结论:巴瑞替尼治疗进展期白癜风安全有效,其疗效受治疗时间、皮损部位的影响。     

基于LC-MS非靶向代谢组学分析进展期白癜风血清代谢物差异

目的 研究进展期白癜风患者与健康人血清中的差异代谢物。方法 招募进展期白癜风患者59例和健康对照58例。采用高效液相色谱——质谱联用仪器检测非靶向血清代谢物。经主成分分析,偏最小二乘法判别分析等方法筛选相关差异生物标志物,利用KEGG数据库对筛选的差异代谢物进行注释和通路富集。结果 在进展期白癜风患者以及健康对照的血清样本中检测出336个代谢物,在两组血清样本之间存在10种显著差异代谢物。与对照组相比,下调代谢物包括：胡椒碱和泛酸;上调代谢物包括：1-硬脂酰基甘油、硬脂酰乙醇酰胺、咪唑乙酸、硬脂酸、二十碳五烯酸、油酰乙醇酰胺、胆红素和尿苷。与差异性代谢物显著相关的关键代谢通路为不饱和脂肪酸的生物合成通路(P<0.05)。结论 本研究利用代谢组学分析,发现进展期白癜风患者和健康人血清代谢产物差异性以及特征化合物,为揭示白癜风发病机制提供基础,为临床辅助疾病诊断、治疗及预后提供新的视角。     

糖皮质激素受体在白癜风患者外周血单核细胞中的表达

本研究通过检测不同类型白癜风患者外周血单核细胞中糖皮质激素受体（GCR）的表达水平,探讨其在白癜风发病中的作用。[第一段]     

寻常型进展期白癜风患者外周血T淋巴细胞Fas和FasL的表达

目的：检测寻常型进展期白癜风患者外周血T淋巴细胞Fas和FasL的表达。方法：随机采集30例寻常型进展期白癜风患者（实验组）外周血3mL,分离T淋巴细胞后进行细胞涂片,使用免疫组化和原位杂交方法检测Fas和FasL蛋白和FasLmRNA水平的表达。并以30例静止期患者（对照组A）和20例健康志愿者（对照组B）作对照。结果：3组间Fas的表达差异无统计学意义（P〉0．05）。与两组对照组相比,实验组FasL的表达明显增加（P〈0．001）。与对照组B相比,对照组A FasL的表达显著增加（P〈0．001）。结论：寻常型进展期白癜风患者外周血T淋巴细胞FasL的表达显著增加。     

308nm准分子光治疗白癜风疗效评价

目的：评价308nm准分子紫外光治疗白癜风的临床疗效。方法：31例进展期和34例稳定期白癜风患者皮损行308nm准分子紫外光治疗,共照射30次。结果：进展期和稳定期白癜风患者总有效率分别为62．14％、73．52％,无显著性差异（P〉0．05）。头面部及躯干部效果较好,肢端效果最差。结论：308nm准分子紫外光治疗白癜风安全有效,其疗效与皮损部位相关,与进展期或稳定期无关。     

中波高能紫外线治疗儿童白癜风疗效评价

目的:评价中波高能紫外线治疗儿童白癜风的临床疗效及安全性。方法:采用美国Dua LightTM型高能紫外线治疗仪UV120-2型治疗40例儿童白癜风患者50处皮损,以l~2倍MED值作为治疗起始量,根据治疗后皮损的反应,每次照射剂量不变或增加15%,每周治疗1~2次,6个月后评价疗效。结果:皮损的总有效率为62%,痊愈率为26%。头面部、躯干部、四肢及肢端有效率分别为81.8%,83.3%,37.5%及0。无严重不良反应。结论:中波高能紫外线治疗儿童白癜风安全有效,病变部位与疗效相关。     

Assessment of the immune system in 55 Iranian patients with vitiligo

BACKGROUND: Vitiligo is an acquired idiopathic hypomelanotic disorder characterized by circumscribed depigmented macules resulting from the loss of cutaneous melanocytes. OBJECTIVE: In order to evaluate the immune system of Iranian patients with vitiligo, this study was accomplished. METHODS: Fifty-five Iranian patients with vitiligo and 60 healthy persons as control were investigated in this study. The laboratory techniques were included: antimelanocyte antibody (AMA) and antinuclear antibody (ANA) with indirect immunoflorescent test, C3 and C4 levels with single radial immunodiffusion (SRID), and rheumatoid factor (RF) with enzyme-linked immunosorbent assay (ELISA). RESULTS: AMA was positive in 17 patients (30.9%) and was negative in the entire control group (P < 0.0001). ANA was positive in 4 patients (7.3%), which was insignificantly higher than control group (1.7%). IgM-RF was positive in 6 patients (10.8%) while it was negative in the entire control group (P = 0.027). C3 and C4 values decreased in 14 patients (25.5%), which was significantly higher than control group (P < 0.001). CONCLUSION: The important role of the immune system in the pathogenesis of vitiligo could be suggested. In addition, the autoimmune hypothesis of vitiligo could be confirmed based on the results of this study.     

中波高能紫外线联合他克莫司软膏治疗白癜风疗效评价

目的:评价中波高能紫外线联合他克莫司软膏治疗白癜风的临床疗效。方法:120例白癜风患者随机分成3组,治疗组40例,采用304 nm中波高能紫外线联合他克莫司软膏治疗;对照1组40例,单纯予304nm中波高能紫外线治疗;对照2组40例,单纯给予他克莫司软膏治疗。治疗12周后评价疗效。结果:治疗组有效率87.50%,对照1组为67.50%,对照2组为42.50%,差异有统计学意义(P0.05)。结论:中波高能紫外线联合他克莫司软膏治疗白癜风临床疗效优于中波高能紫外线单独照射或他克莫司软膏单独外用。     

窄谱UVB治疗白癜风疗效及黑素恢复观察

近年来人们报道用窄谱UVB治疗白癜风有明显疗效,成为临床治疗白癜风的方法之一[1].然而,不同文献显示窄谱UVB对白癜风的临床疗效不尽相同,推测与多种影响因素有关[2].     

准分子光治疗白癜风的临床疗效观察

目的:观察准分子光治疗局限型、散发型、节段型白癜风的临床疗效。方法:治疗组37例(57片皮损)予308 nm准分子光照射,对照组36例(55片皮损)予304 nm中波高能紫外线照射,两组均为每周2次,治疗8周。结果:治疗组有效率为64.91%,对照组为58.18%;差异无统计学意义(P0.05)。两组不同分型、分期皮损有效率差异无统计学意义(P均0.05)。两组均无明显皮肤不良反应。结论:准分子光治疗局限型、散发型、节段型白癜风疗效较好且皮肤不良反应较低。     

Chronological clinicopathological characterization of rapidly progressive alopecia areata resistant to multiple i.v. corticosteroid pulse therapies: An implication for improving the efficacy

Intravenous corticosteroid pulse therapy (pulse therapy) has been reported to be effective for rapidly progressive alopecia areata (RP‐AA). Mostly, a single 3‐day administration of corticosteroid (methylprednisolone 500 mg/day) has been performed in Japan; however, to what extent additional administrations improve the outcome has not been fully elucidated. To assess the advantage of repeating the pulse therapy to RP‐AA cases refractory to the initial intervention, retrospective clinicopathological analysis was performed. Detailed chronological analysis was conducted in eight cases (one man and seven women; average age, 38.3 ± 10.4 years) demonstrating total scalp hair loss 3 months after the first pulse therapy and treated with additional rounds of the pulse therapy. All cases manifested total hair loss, scalp edema, itch or pain on the scalp after the initial intervention. Histopathological analyses of affected lesions prior to additional pulse therapies revealed persisting dense perifollicular lymphocytic inflammation in all cases. Interestingly, such inflammatory change tended to be severer when compared with previously reported pulse therapy good responders. Extra pulse therapy resulted in partial regrowth of terminal hairs in three out of eight cases, but all of them experienced relapse in the long run. The literature review also suggested limited efficacy of repeating pulse therapy to severe AA cases. These findings suggested that the efficacy of currently conducted repetitive pulse therapy is limited in RP‐AA cases with extensive perifollicular inflammation and resistant to the initial pulse therapy. Modulation of the dose and the interval of intervention, in combination with alternative approaches, may be required to achieve a successful outcome.     

单株毛囊移植联合光疗治疗白癜风白发疗效评价

目的：评价单株毛囊移植（FUE）联合光疗治疗顽固性白癜风伴毛发变白的治疗效果。方法：选取2019年6月至2020年12月稳定期伴毛发变白的白癜风患者,将单株毛囊移植于白癜风皮损区域内, 血痂脱落后,皮损区给予308准分子激光照射,初始剂量50 mJ,1周照射2~3次,3个月一个疗程。结果：入选患者20例, 共25处白斑,治疗3个月后,19处出现移植毛囊周围的色素恢复,其中痊愈2处,显效17处;24处皮损出现黑色毛发生长。结论：单株毛囊移植（FUE）联合光疗治疗顽固性白癜风可有效改善顽固性白癜风伴毛发变白。