窄谱中波紫外线治疗白癜风平台期相关研究

目的:研究窄谱中波紫外线(NB-UVB)治疗白癜风疗效与初始复色和平台期之间的关系,并测试一个疗程光疗后色素脱失斑恢复到首次光疗时光敏感度所需的时间。方法:选取符合要求的66例患者,以拍照的方式记录光疗期间患者的复色情况,比较有效和无效的患者初始复色时光疗次数、有效复色期间光疗总次数、平台期出现时光疗次数的差异。进入平台期后以靶色素脱失斑的最小红斑量对剩余色素脱失斑定期进行2 cm×2 cm面积的照射,并记录出现淡红斑的时间。结果:有效患者与无效患者之间,初始复色出现的早晚比较,差异有统计学意义(P0.05);二者有效复色期间光疗总次数比较,差异有统计学意义(P0.05);而二者平台期出现的早晚比较,差异无统计学意义(P0.05)。初始复色出现的早晚与平台期出现的时间无关(P0.05)。光耐受持续的时间为30~75 d。结论:NB-UVB治疗白癜风疗效与初始复色出现的早晚有关,与平台期出现的早晚无关;不论疗效如何,光疗到一定次数后平台期均会出现,光耐受色素脱失斑恢复光敏感时间集中在45~75 d。     

白癜风自体表皮移植联合光疗与调节性T细胞水平的关系

目的探讨CD4^＋CD25^＋Foxp3^＋调节性T细胞水平在白癜风自体表皮移植联合光疗中的变化。方法用流式细胞仪直接免疫荧光检测稳定期自体表皮移植联合窄谱中波紫外线（NB-UVB）治疗前后的20例白癜风患者及19例正常人外周血CD4^＋CD25^＋调节性T细胞转录因子Foxp3^＋的表达水平。结果稳定期白癜风移植患者接受照光前的CD4^＋CD25^＋Foxp3^＋调节性T细胞百分率比正常人稍低,差异无显著性（P〉0．05）,联合NB-UVB始疗后的患者CD4^＋CD25^＋Foxp3^＋调节性T细胞百分率较照光前明显增加,差异有显著性（P〈0．05）,与正常组相比差异无显著性（P〉0．05）。结论CD4^＋CD25^＋Foxp3^＋调节性T细胞可能在白癜风光疗中起一定的作用,NB—UVB光疗可能通过增加调节性T细胞数量来促进移植后复色。     

他卡西醇软膏联合窄谱中波紫外线治疗白癜风临床疗效观察

窄谱中波紫外线（NB—UVB）照射是目前治疗白癜风的有效疗法。他卡西醇是维生素D3的类似物,外用有利于白癜风复色。笔者在2005年3月-2006年2月应用他卡西醇软膏（商品名：萌尔夫,上海百润有限公司）联合NB—UVB照射治疗白癜风,取得较为满意疗效。现将观察结果和治疗体会报告如下。     

医院与家用窄谱中波紫外线治疗白癜风的疗效观察北大核心CSCD

目的比较医院与家用窄谱中波紫外线（NB-UVB）治疗白癜风的疗效及患者接受度。方法 2016年8月至2017年9月在杭州市第三人民医院皮肤科门诊收集80例白癜风患者,随机分为家用光疗组和医院光疗组,每周照射2次,疗程均为36次。疗程结束后评估两组疗效、不良反应及患者接受度。结果 最终完成治疗家用光疗组39例,医院光疗组37例。家用光疗组面颈、躯干、四肢治疗有效率分别为62．5％、48．6％、42．3％,医院光疗组分别为66．7％、55．9％、48．6％。两组相应部位疗效、皮损初始复色累积剂量、疗程结束累积剂量比较,差异均无统计学意义。家用光疗组不良反应发生率（61．5％）显著高于医院光疗组（24．3％,P〈0．05）,家用光疗组单次治疗耗时（27．95min）短于医院光疗组（129．73min,P〈0．05）。家用光疗组接受度随疗效增加评分升高（β=0．483,t=4．573,P〈0．001）,随治疗耗时的增加降低（届=-0．569,t=-5．831,P〈0．001）;医院光疗组接受度随疗效增加上升（β=0．758,t=7．547,P〈0．001）,但与治疗耗时无显著相关性（β=-0．204,t=-2．030,P=0．05）。结论 家用光疗和医院光疗两者可互为补充,针对不同患者选择合适的治疗方法,可增强患者依从性,是提高疗效的必要条件。     

308nm准分子激光治疗面部局限型稳定期白癜风患者不同分区的疗效

目的 总结和分析面部局限型稳定期白癜风不同分区的疗效.方法 回顾性分析我科于2011年10月一2013年5月应用308 nm准分子激光治疗的112例面部局限型稳定期白癜风患者的临床资料,统计分析面部不同分区的疗效.结果 鼻区复色最好,依次为颊区、额区、口区、眼区（P=0.000）.75％的鼻区皮损,9.09％的颊区皮损完全复色,额区无皮损完全复色,6.98％的口区皮损,9.52％的眼区皮损完全复色.病程与疗效呈负相关（R=-0.070,P=-0.032）,病程短的面部稳定期局限型白癜风患者疗效更好.随着治疗次数（R=0.389,P=0.000）、红斑量（B=0.349,P=0.000）、累积剂量（R=0.065,P=0.033）的增加疗效增加,平台期的出现与三者有关.结论 308 nm准分子激光治疗面部局限型稳定期白癜风安全有效,面部不同分区的皮损疗效不同.     

窄谱中波紫外线对寻常型银屑病神经生长因子及其受体mRNA的影响

目的：观察窄谱中波紫外线（NB—UVB）治疗寻常型银屑病的疗效及治疗前后皮损中神经生长因子（NGF）及受体的表达。方法：用NB—UVB治疗23例寻常型银屑病患者,每周3次,连续21次,以PASI评价疗效,并以原位杂交技术和图像分析系统分析皮损部位光疗前后NGF及受体mRNA的表达情况。结果：临床总有效率为91％,光疗后PASI评分较光疗前显著降低（P〈0．001）;光疗前银屑病皮损处NGFmRNA在从基底层到颗粒层均有阳性表达,P140TrkAmRNA在表皮各层均有染色,以棘细胞层和颗粒层染色较强,P75mRNA在棘细胞层和颗粒层有较强染色;光疗后三者mRNA表达强度明显降低（P〈0．01）。结论：NB—UVB是治疗银屑病的安全有效的方法,下调皮损中NGF及受体的表达可能是NB—UVB治疗寻常型银屑病的机制之一。     

羟氯喹逆转紫外线诱导的SLE患者CD4+T细胞DNA低甲基化的研究

目的 探讨羟氯喹对紫外线诱导的SLE患者CD4+ T细胞基因组DNA低甲基化的作用。方法 选择SLE患者组30例,正常人对照组10例。 磁珠分选SLE患者组和正常人对照组外周血CD4+ T细胞,311 nm窄谱UVB照射,加入羟氯喹共培养,检测各组间基因组DNA甲基化表达水平。结果 SLE患者组CD4+ T细胞DNA甲基化水平（3.922 ± 2.215）%低于正常人对照组［（10.210 ± 5.573）%,t = 3.450,P = 0.026］;SLE活动组患者CD4+ T细胞经45 mJ/cm2和100 mJ/cm2 UVB照射后DNA甲基化水平为（1.784 ± 1.033）%和（1.932 ± 1.844）%,均显著低于活动期患者未照射组［（3.922 ± 2.215）%,t = 3.000、4.118,P值均 < 0.05］。经100 mJ/cm2 UVB照射后,活动期患者DNA甲基化水平（1.932 ± 1.844）%显著低于稳定期患者照射组 ［（7.235 ± 3.846）%,t = 2.648,P < 0.05］和正常人对照组［（5.472 ± 5.573）%,t = 3.000,P < 0.05］。SLE活动组T细胞经45和100 mJ/cm2 UVB照射后,加用羟氯喹结果DNA甲基化水平为（4.698 ± 1.948）%和（8.698 ± 3.151）%,均比照射未加羟氯喹组显著升高（t = 4.827、3.184,P值均 < 0.05）;经45 mJ/cm2 UVB照射前后均加羟氯喹组DNA甲基化水平（5.404 ± 2.308）%比照射未加羟氯喹组（1.784 ± 1.033）%显著升高,t = 4.827,P < 0.01。结论 羟氯喹可以逆转紫外线诱导的SLE患者CD4+ T细胞DNA低甲基化,羟氯喹对活动期SLE患者更为明显。     

特应性皮炎患者血清维生素D检测及其临床意义

目的 检测特应性皮炎（AD）患者血清中维生素D（VitD）、总免疫球蛋白E（tIgE）、白细胞介素4（IL?4）、IL?6水平,评价VitD与AD患者病情严重程度的关系及其在AD发病中炎症与免疫调节中的作用。方法 采集37例AD组和30例对照组外周血,检测血清VitD、tIgE、IL?4、IL?6水平,通过SCORAD评分评估AD患者病情严重程度。采用t检验或U检验分析组间差异,采用χ2检验比较VitD缺乏、不足与充足患者比例,采用Pearson或Spearman相关进行各组间的相关性分析。结果 AD组血清VitD水平［（24.77 ± 9.29） μg/L］低于对照组［（28.98 ± 6.87） μg/L,t = 2.015,P = 0.048］,tIgE水平［137.68（37.59 ~ 414.53） IU/ml］高于对照组［45.16（14.56 ~ 112.12） IU/ml,Z = -3.399,P = 0.001］,IL?4水平［（8.86 ± 4.83） ng/L］高于对照组［（4.78 ± 3.07） ng/L,t = 4.147,P < 0.001］,IL?6水平［6.53（3.99 ~ 15.30） ng/L］高于对照组［4.58（2.85 ~ 8.17） ng/L,Z = -2.173,P = 0.030 ］。AD组SCORAD评分与血清VitD水平负相关（r = -0.505,P = 0.001）,与tIgE、IL?4水平正相关（r值分别为0.531、0.519,P值均为0.001）,与IL?6无相关性（r = -0.139,P = 0.411）。AD组与对照组相比,VitD缺乏、不足与充足患者比例差异有统计学意义,χ2 = 8.762,P = 0.013。VitD缺乏患者血清tIgE［2846.87（319.02 ~ 7300.00） IU/ml］与IL?4水平［（16.37 ± 2.05） ng/L］分别高于VitD不足［110.07（26.20 ~ 501.48） IU/ml,P = 0.045;（8.28 ± 4.48） ng/L,P = 0.011］和VitD充足患者［123.93（91.61 ~ 273.68） IU/ml,P = 0.024;（8.00 ± 4.63） ng/L,P = 0.041］。VitD缺乏患者IL?6水平［15.10（8.49 ~ 30.72） ng/L］高于充足［6.22（4.47 ~ 9.47）ng/L,P = 0.011］。结论 AD患者存在VitD缺乏或不足,VitD缺乏与高水平tIgE、IL?4、IL?6有关,且AD的严重程度与tIgE、IL?6升高及VitD降低关系密切。     

他克莫司软膏联合窄谱中波紫外线照射治疗白癜风疗效观察

目的观察他克莫司软膏联合窄谱中波紫外线（NB—UVB）照射治疗白癜风的,临床疗效及安全性。方法将90例白癜风患者随机分为三组。试验组30例外用他克莫司软膏联合窄谱UVB（NB—UVB）照射治疗,对照1组30例行NB—UVB单纯照射治疗,对照2组30例外用他克莫司软膏治疗。三组均连续治疗3个月,进行临床疗效和不良反应评价。结果试验组总有效率明显高于对照1组及2组（P〈0．05）;三组均无严重不良反应发生。结论他克莫司软膏联合NB—UVB治疗白癜风疗效确切,安全性好。     

慢性荨麻疹患者血清中Ｄ-二聚体水平和IL-33表达及意义

 目的:探讨慢性荨麻疹（CU）患者血清中D-二聚体水平和 IL-33的水平及其临床意义。方法:将63例CU患者依据自身血清皮肤试验（ASST）结果进行分组,取同期体检健康者作为对照组,采用ELISA法检测三组患者血清中D-二聚体水平和 IL-33水平并进行比较。结果:63例CU患者中,37例ASST阳性（58.73%）,26例阴性（41.27%）。相比对照组D-二聚体水平［2.437 ±0.120） mg/L］,ASST（+）组 ［（25.797±7.756） mg/L］和ASST（-）组［（30.605±9.101）mg/L］均明显增加（t值分别为10.25、10.58,P值均<0.05）,但ASST（-）组与ASST（+）组两组间无明显差异（t=1.39, P＞0.05）。ASST（+）组血清中IL-33含量 ［（0.237±0.037） pg/mL］明显高于对照组［（0.069±0.001） pg/mL］,t=7.78,P<0.05,而ASST（-）组IL-33水平［（0.112±0.028） pg/mL］无明显变化（t=2.63, P＞0.05）,ASST（-）和ASST（+）间有明显差异（t=4.69, P<0.05）。结论:CU患者血清中D-二聚体水平及ASST（+）组IL-33水平升高,可能导致机体免疫系统失衡,在CU的发生与发展中发挥一定作用。     

“7．23”动车事故应急医疗救治

2011年7月23日,北京至福州D301次列车行驶至温州双屿路段时,与杭州开往福州D3115次列车追尾造成大量人员伤亡。事故发生后,浙江省温州市医疗卫生系统迅速反应,启动应急联动机制,院外急救转送与院内紧急抢救环环相扣,较好地完成此次事故的医学救援工作。     

Dramatic response of chronic ulcerating necrobiosis lipoidica to ultraviolet A1 phototherapy

We report on a 52-year-old female patient with chronic, ulcerating necrobiosis lipoidica (NL) who dramatically responded to ultraviolet A1 (UVA1) phototherapy. The patient had NL on her right shin for more than 30 years without evidence of diabetes mellitus. Treatment with a variety of local and systemic agents failed to prevent progression into ulceration, which necessitated repeated surgical interventions in the past. When the patient presented again with torpid ulcers at the periphery of previously grafted skin, high-dose UVA1 phototherapy was initiated. Improvement occurred rapidly and after 22 irradiations and a total exposure dose of 1480 J/cm2, the ulcers had healed completely. During a follow-up period of 6 years,two minor recurrences were successfully retreated with UVA1 phototherapy.     

Enhanced response of childhood psoriasis to narrow-band UV-B phototherapy with preirradiation use of mineral oil

Studies in adults show that pretreatment with an optimal emollient may improve transmission of ultraviolet-B. In our study, we evaluated whether the preirradiation use of mineral oil enhanced the efficacy of narrow-band ultraviolet-B phototherapy in childhood psoriasis. Twenty children, aged 5 to 14 years with widespread, symmetrical psoriasis involving >20% body surface area were enrolled in a prospective, single-blind, controlled study. Mineral oil was applied prior to irradiation over one half of the body and the other half was emollient-free control. Narrow-band ultraviolet-B phototherapy was administered to whole body twice a week on nonconsecutive days with initial dose of 50 mJ/cm(2) and increment of 10% at each session. Clinical response was evaluated as grades of erythema, scaling and induration, area of involvement and modified psoriasis area severity index score on each side at baseline, 3, 6, 9, and 12 weeks. Two patients dropped out, 18 patients completed the study. Significantly greater improvement (p < 0.05) in scaling, induration, area of involvement, and modified psoriasis area severity index score was seen on the mineral oil pretreated side as early as 3 weeks and was maintained throughout the study. Difference in erythema was noticed later at 6 weeks. The cumulative dose for clearance was significantly lower on the emollient pretreated side. No adverse effects were observed with mineral oil or narrow-band ultraviolet-B phototherapy. We conclude that preirradiation use of mineral oil enhances the therapeutic efficacy of narrow-band ultraviolet-B phototherapy in children with widespread psoriasis.     

Progressive macular hypomelanosis, excellent response with narrow-band ultraviolet B phototherapy

Progressive macular hypomelanosis (PMH) is an acquired disorder of skin pigmentation, which is mostly under‐diagnosed. It is characterized by nummular hypopigmented lesions appearing on the trunk in young persons. Several treatment options are available, although topical clindamycin and benzoyl peroxide have been used traditionally. However, good results have recently been achieved using narrow‐band ultraviolet B (NBUVB) phototherapy. We present the case of a 13‐year‐old girl with hypopigmented lesions on the trunk and limbs that had progressed over 1 year and that were diagnosed as PMH. The patient was initially treated with topical clindamycin and benzoyl peroxide. However, little improvement was seen and treatment was then started with NBUVB phototherapy. After 25 sessions, with a total cumulative dose of 18 J/cm², the patient showed almost total repigmentation of the lesions. The treatment of PMH is often difficult, and very little is currently known about the treatment response in this disorder, as most reports have very small series of patients with a short disease progression time. NBUVB phototherapy has been shown to be effective, as seen in our patient, although in many cases, there is recurrence after the cessation of treatment.