308-nm准分子激光联合他克莫司软膏治疗面部白癜风656例疗效评价

目的：评价308nm准分子激光联合他克莫司软膏治疗面部白癜风的疗效。方法：对656例面部白癜风患者照射308nm准分子激光联合外用他克莫司软膏。他克莫司软膏每日2次,308nm准分子激光每周治疗1-2次,共治疗30次。末次治疗后随访1年。结果：1630块白斑中,总有效率为47.12%,病程<2年皮损总有效率为58.10%高于病程≥2年皮损的16.60%,两组差异具有统计学意义(P<0.001)。眼周皮损疗效最佳,总有效率为54.96%,口周皮损疗效最差,总有效率为40.22%,差异有统计学意义（P<0.0001）。结论：308 nm准分子激光联合他克莫司软膏治疗面部白癜风的疗效与病期和皮损部位有关。     

308nm准分子激光联合0.1%他克莫司软膏治疗寻常性银屑病疗效观察

目的探讨308nm准分子激光联合0.1%他克莫司软膏治疗寻常性银屑病的临床疗效。方法所有参加研究的患者均接受308nm准分子激光照射2次/w,共6周,且皮损处外搽0.1%他克莫司软膏,早、晚各1次,疗程6周。每2周根据皮损进行治疗前及治疗后的PASI评分比较。结果308nm准分子激光照射平均次数为7.31(5～11)次,外搽0.1%他克莫司软膏平均次数为79.2(69～91)次,治疗6周结束后平均PASI评分为3.15(3.34±1.98),治疗前平均PASI评分为15.31(17.59±3.67),有效率81.40%,治疗前、后2次PASI评分比较,差异有统计学意义(P<0.05)。不良反应轻微,发生率为20.93%。结论308nm准分子激光联合0.1%他克莫司软膏治疗寻常性银屑病疗效好,不良反应少。     

Evaluation of 308-nm monochromatic excimer light in the treatment of psoriasis vulgaris and palmoplantar psoriasis

Background: The purpose of this study is to evaluate the efficacy and safety of 308‐nm monochromatic excimer light (MEL) in the treatment of psoriasis vulgaris and palmoplantar psoriasis. Methods: Thirty‐five patients with psoriasis vulgaris and 15 patients with palmoplantar psoriasis were recruited for this study. Thirty patients with psoriasis vulgaris completed a total of 16 treatments with 308‐nm MEL twice a week, and 15 patients palmoplantar psoriasis completed 25 treatments administered once weekly. The clinical response to therapy and adverse effects were recorded. Results: Patients with psoriasis vulgaris (n=30) showed a 74.6% improvement in the mean psoriasis area and severity index score after a total of 16 MEL treatments (2 ×/week) with 36.7% of the patients (n=11) achieving clearance. Patients with palmoplantar psoriasis (n=15) showed a 52.5% improvement in the mean severity index score after a total of 25 MEL treatments (1 ×/week) with only one patient (6.7%) achieving clearance. The MEL therapy was well tolerated with a low incidence of side effects, which included pruritus, erythema and blister formation. Conclusion: The 308‐nm MEL can be utilized as an effective and safe treatment modality for patients with mild‐to‐moderate psoriasis vulgaris and palmoplantar psoriasis.     

Successful treatment of plasma cell cheilitis with topical tacrolimus: report of two cases

Plasma cell cheilitis is an uncommon chronic inflammatory dermatitis that presents with flat to slightly elevated erosive erythematous plaques. It is histologically characterized by plasma cell infiltrates into the mucosa. Other than the lip, genital areas are often involved, which is called plasma cell balanitis or vulvitis. Plasma cell cheilitis is sometimes resistant to conventional topical corticosteroid therapy. Other choices include oral griseofulvin, topical cyclosporine, and intralesional corticosteroid injection, all of which occasionally fail to produce satisfactory results. Recent reports show that topical calcineurin inhibitors are effective for plasma cell cheilitis, balanitis, and vulvitis. However, there are so far only 2 reports of plasma cell cheilitis successfully treated with topical pimecrolimus and tacrolimus. We present herein two cases of plasma cell cheilitis, in which topical tacrolimus showed beneficial effects, suggesting that this immunomodulatory agent is a promising option for plasma cell cheilitis.     

308nm单频准分子光治疗寻常性银屑病和掌跖银屑病临床疗效观察

目的:评估308nm单频准分子光局部照射治疗寻常性银屑病和掌跖银屑病的临床疗效及安全性。方法:采用单频准分子光局部照射治疗35例寻常性银屑病和15例掌跖银屑病患者皮损,每周照射1次或2次,每2周评估疗效1次,并记录不良反应。结果:30例寻常性银屑病患者经16次照射,有效率达70%,慢性斑块型疗效较好。15例掌跖银屑病患者经25次照射,有效率为53.3%。单频准分子光局部照射主要不良反应为瘙痒,局部出现红斑,偶有水疱。结论:308nm单频准分子光局部照射治疗寻常性银屑病和掌跖银屑病见效快,疗程短,且不良反应少。     

他克莫司软膏联合308nm高能准分子光治疗面颈部白癜风临床疗效观察

目的观察他克莫司软膏联合308nm高能准分子光治疗面颈部白癜风的临床疗效。方法白癜风患者134ff4,随机分为3组。联合治疗组采用他克莫司软膏联合308nm高能准分子光治疗,他克莫司治疗组仅用他克莫司软膏治疗,准分子光治疗组仅用308nm高能准分子光治疗。3个月为1个疗程,根据色素恢复的程度评价临床疗效。结果联合治疗组有效率为95．5％,他克莫司治疗组为58_3％,308nm高能准分子光治疗组为78．6％,组间差异均有统计学意义（P〈0．05,P〈O．01）。结论他克莫司软膏联合308nm高能准分子光治疗白癜风效果较好。     

他卡西醇联合单频准分子光治疗白癜风的对照研究

目的 评价和对比他卡西醇联合单频准分子光(MEL)308nm和单用单频准分子光治疗白癜风的疗效和安全性。方法 用单盲、自身对照的方法对38例白癜风患者的自身对称或相邻的皮损分别外用他卡西醇和安慰剂,两侧皮损每周照射1次MEL 308 nm,1月观察1次,拍照对比疗效。计算最初色素再生和显效时的照光次数和光的累积量。结果 对35例患者进行评价,联合治疗侧最初色素再生时的照光次数和光的累积量分别为(4.89±3.16)次和(4.27±3.59)J/cm²,单照光侧分别为(5.69±3.29)次和(5.36±4.12)J/cm²(P<0.05),显效的患者联合治疗侧为(7.79±4.70)次和(7.72±5.64)J/cm²,单照光侧为(8.4±3.92)次和(8.18±4.87)J/cm²(P>0.05)。联合治疗侧的显效率为45.7%,总有效率71.4%,单照光侧分别为25.7%和54.3%(P<0.05)。结论 单频准分子光治疗白癜风有效而且安全,联合他卡西醇外用可增强MEL 308 nm的疗效,提早色素再生的时间和减少照光的能量。     

Topical tacalcitol and 308-nm monochromatic excimer light: a synergistic combination for the treatment of vitiligo

BACKGROUND/PURPOSE: To study and compare the efficacy of combined 308-nm monochromatic excimer light (MEL) therapy with tacalcitol vs. that of MEL 308-nm therapy alone in treatment of vitiligo. METHODS: Thirty-eight patients with vitiligo were enrolled in a single-blind, within patient controlled clinical trial. Symmetrical or nearby lesions were randomly applied with either topical tacalcitol cream or vehicle. Each lesion was treated weekly with the 308-nm MEL, for a total of 12 sessions. Patients were examined at monthly intervals. The mean number of sessions and the cumulative dosage for initial repigmentation were calculated. RESULT: Thirty-five patients were evaluated. Treatment with tacalcitol and MEL resulted in higher percentages for excellent repigmentation (25.7%) compared with vehicle and MEL (5.7%) (P<0.05). Percentages for total response were 71.4% and 60%, respectively (P>0.05). The mean+/-SEM cumulative dose and number of excimer light exposures for initial repigmentation were, respectively, 3.93+/-0.59 J/cm2 and 4.52+/-0.49 at the tacalcitol side, and, respectively, 4.99+/-0.68 J/cm2 and 5.3+/-0.52 at the vehicle side (P<0.05). CONCLUSION: Our results have shown that concurrent topical tacalcitol potentiates the efficacy of the 308-nm MEL in the treatment of vitiligo, and that this combination achieves earlier pigmentation with a lower total dosage.     

308 nm单频准分子光对人黑素细胞膜凋亡、周期和KIT蛋白表达的影响

目的 探讨308 nm单频准分子光对体外培养的人黑素细胞凋亡、细胞周期和KIT蛋白表达的影响。方法 在流式细胞仪上采用AnnexinⅤ检测0，20，40，80，160，300 mJ/cm2剂量308 nm单频准分子光照射后24 h黑素细胞的凋亡；采用碘化丙啶检测80 mJ/cm2照射后24 h细胞周期的变化。实时荧光PCR和Werstern印迹分别检测0，20，40，80，160，300 mJ/cm2剂量照射后24 h黑素细胞c-kit mRNA和KIT蛋白的表达。结果 照射后24 h，在小于160 mJ/cm2剂量下，黑素细胞凋亡无明显增加，但300 mJ/cm2时的凋亡率与对照相比较明显增加（P < 0.05）。80 mJ/cm2剂量照射后24 h，S期细胞数明显高于其对照，分别为29.06% ± 0.75%和22.64% ± 0.07%；低剂量308 nm单频准分子光照射后24 h，c-kit mRNA表达呈先增加后减少的趋势，80 mJ/cm2时达高峰，KIT蛋白的表达与mRNA的表达趋势一致。结论 低剂量308 nm单频准分子光（80 mJ/cm2）促进黑素细胞增殖和KIT的表达。     

Association of khellin and 308-nm excimer lamp in the treatment of severe alopecia areata in a child

Alopecia areata (AA) is an autoimmune inflammatory disorder of hair, characterized by non-scarring hair loss. A 308-nm excimer lamp (EL) has been reported as one effective modality in the treatment of AA. Khellin is a furanochromone photosensitizer whose chemical structure is close to psoralens and has previously proven its efficacy in vitiligo in association with ultraviolet A. We evaluated the efficacy and safety of a combination of topical khellin and 308-nm EL in the treatment of a refractory ophiasic AA, of 1-year evolution, in a 5-year-old boy. Treatment consisted in topical application of khellin 45 mn before irradiation with EL (starting dose 50 mJ/cm²) twice a week for 3 months. The result was a complete regrowth of hair with no recurrence 1 year later. Further studies should be carried out to confirm this promising result and to propose khellin–excimer as a new alternative treatment for resistant cases of AA in children.     

A review of monochromatic excimer light in vitiligo

Phototherapy is a mainstay of vitiligo treatment and has varying rates of efficacy. Narrowband ultraviolet (UV) B (NB‐UVB) and UVA have been used for decades, but it is only recently that monochromatic excimer light (MEL) was developed for use in dermatology and adapted for the treatment of vitiligo. The specific 308‐nm radiation wavelength is delivered in a targeted form by the xenon‐chloride excimer laser and is also available in an incoherent form that is commonly referred to as the excimer lamp. MEL administered by both laser and lamp has shown efficacy superior to NB‐UVB for the treatment of vitiligo and induces more changes at the cellular level than conventional UVB modalities. The excimer laser is effective in adults and children with vitiligo in all skin types as monotherapy or in combination with other established vitiligo therapeutics. Treatment regimens studied included excimer laser two to three times weekly for up to 36 weeks. Patients commonly achieved > 75% repigmentation. The laser has also been used in combination with topical corticosteroids, calcineurin inhibitors and vitamin D analogues, as well as surgery, thus further expanding treatment options for patients with vitiligo. The excimer lamp has been used for treatments one to three times a week for up to 24 weeks and was found to be equal to excimer laser in a head‐to‐head comparison. It has also been used in combination with topical corticosteroids and oral vitamin E. Both MEL modalities have a limited adverse side‐effect profile. Long‐term effects are yet to be determined; however, based on available data on UVB phototherapy as well as the properties of MEL devices, there is probably only a minimal increased malignancy risk.     

Response of oral lichen planus to topical tacrolimus in 37 patients

BACKGROUND: Topical tacrolimus has been reported to be effective for the treatment of oral lichen planus. This article describes our experience with topical tacrolimus in patients treated for symptomatic oral lichen planus. OBSERVATIONS: A survey was mailed to 40 patients with symptomatic oral lichen planus treated with topical tacrolimus. Surveys were completed by 37 patients (93%) a mean of 1.3 years after initiation of treatment. Thirty-three (89%) of the 37 patients reported symptomatic improvement, and 31 (84%) reported partial to complete lesion clearance while using topical tacrolimus. On average, patients noted improvement in 1 month. Twelve patients (32%) reported adverse effects consistent with those reported previously (ie, burning, irritation, and tingling). Among the 28 patients still using the medication, 15 patients (54%) apply it at least once daily. Of the 9 patients who discontinued using the medication, 5 experienced recurrence. CONCLUSIONS: Topical tacrolimus is effective for the treatment of oral lichen planus. Most patients experienced symptomatic improvement in less than 1 month. However, the effect is temporary; when topical tacrolimus is discontinued, oral lichen planus may flare again.     

Monochromatic excimer light 308 nm in the treatment of vitiligo: a pilot study

OBJECTIVE: To study the efficacy and safety of monochromatic excimer light (MEL) on 37 vitiligo patients referred to our clinic. METHODS: In a pilot study, 37 patients (17 males, 20 females) with acrofacial (n=21), focal (n=11), segmental (n=1), and generalized (n=4) vitiligo were treated twice weekly with MEL for a maximum period of 6 months. RESULTS: Thirty-five patients (95%) showed signs of repigmentation within the first eight treatments. The treatment resulted in good repigmentation in 16 patients, and excellent repigmentation in 18 patients. Adverse events were limited to transient erythema. In addition, some patients (n=3) not responding to prior narrow-band UVB (NB UVB) phototherapy showed good results with MEL in our series. CONCLUSIONS: Treatment with 308 nm MEL for vitiligo may be more effective in obtaining rapid repigmentation than phototherapy with NB UVB. The results in this study are similar to those recently reported with a 308 nm excimer laser, but 308 MEL could present some advantages: the possibility of treating larger areas compared to the 308 nm excimer laser, with shorter treatment times and better patient compliance. The overall good results and the early appearance of repigmentation contribute to reducing the cumulative exposure to UV radiation.     

Topical tacrolimus and the 308-nm excimer laser: a synergistic combination for the treatment of vitiligo

OBJECTIVE: To compare the efficacy of combined tacrolimus and 308-nm excimer laser therapy vs 308-nm excimer laser monotherapy in treating vitiligo. DESIGN: Comparative, prospective, randomized, intraindividual study. PATIENTS: Fourteen patients, aged 12 to 63 years, with Fitzpatrick skin types II to IV. INTERVENTION: For each patient, 4 to 10 target lesions were chosen. The treatment applied to each target lesion was randomized by drawing lots. Each lesion was treated twice a week by the 308-nm excimer laser, for a total of 24 sessions. Initial fluences were 12 mcal/cm(2) (50 mJ/cm(2)) less than the minimal erythemal dose in vitiliginous skin. Then, fluences were increased by 12 mcal/cm(2) every second session. Moreover, topical 0.1% tacrolimus ointment was applied twice daily on target lesions receiving the combined tacrolimus and excimer laser treatment (group A). Group B target lesions received only excimer laser monotherapy. For each treated lesion, the untreated lesion on the opposite side served as the control. Tolerance was evaluated by a visual analog scale, and secondary events were recorded at each session. MAIN OUTCOME MEASURE: Treatment efficacy, which was blindly evaluated by 2 independent physicians by direct and polarized light photographs taken before and after treatment. RESULTS: Forty-three lesions were treated (23 in group A and 20 in group B). All patients completed the study. Repigmentation was observed in all group A lesions (100%) and in 17 (85%) of the 20 group B lesions. Repigmentation was not observed in the untreated lesions (control group). A repigmentation rate of 75% or more was obtained in 16 (70%) of the 23 group A lesions and in 4 (20%) of the 20 group B lesions. In UV-sensitive areas (the face, neck, trunk, and limbs, with the exception of bony prominences and extremities), 10 (77%) of 13 group A lesions had a repigmentation rate of 75% or more vs 4 (57%) of 7 group B lesions. In classically UV-resistant areas, 6 (60%) of 10 group A lesions had a repigmentation rate of 75% or more vs 0 of the 13 group B lesions. The mean number of sessions necessary for an improvement of repigmentation was 10 in group A and 12 in group B. Adverse effects have been limited, and tolerance was excellent. CONCLUSIONS: The combination treatment of 0.1% tacrolimus ointment plus the 308-nm excimer laser is superior to 308-nm excimer laser monotherapy for the treatment of UV-resistant vitiliginous lesions (P<.002). The efficacy and the good tolerance of the 308-nm excimer laser in monotherapy for treating localized vitiligo were also confirmed, but this treatment regimen should be proposed only for UV-sensitive areas.     

308‐nm excimer lamp vs. 308‐nm excimer laser for treating vitiligo: a randomized study

Background The 308‐nm excimer laser and 308‐nm excimer lamp have both been shown to be effective in treating vitiligo but a direct comparison has never been performed. Objectives To test the equivalence of these two devices for treating nonsegmental vitiligo. Patients and methods A randomized monocentric study was undertaken. One lesion was treated with the 308‐nm excimer laser and its counterpart with the 308‐nm excimer lamp. Lesions were treated twice weekly with the same dose on both sides for a total of 24 sessions. The evaluation was done by two independent physicians blinded to the treatment on direct light and ultraviolet light photos. Results Twenty patients were included: 17 completed the study and 104 lesions were treated. The two treatments showed similar results in terms of efficacy for a repigmentation of at least 50% (P = 0·006). The lamp induced more erythema than the laser. Conclusions The 308‐nm excimer lamp and laser showed a similar efficacy in treating vitiligo. For the same fluence, the lamp induced more erythema suggesting photobiological differences between the two devices.     

他克莫司软膏联合308nm准分子激光治疗白癜风临床观察

目的评价0.1%他克莫司软膏联合308nm准分子激光治疗白癜风疗效。方法将50例患者分为2组。A组外用0.1%他克莫司软膏联合308nm准分子激光照射,B组单独外用0.1%他克莫司软膏。于12,16周观察疗效。结果治疗12周后A组有效率为68.4%,B组有效率为41.8%,两组间疗效差异有统计学意义(P<0.01)。16周后A组有效率为75.4%,B组有效率为69.1%,两组间疗效差异无统计学意义(P>0.05)。A,B两组不同分期皮损的有效率比较,差异均有统计学意义(P<0.05),进展期疗效均优于稳定期。结论 A,B两组疗法均有效,进展期疗效优于稳定期,A组皮损较B组起效早且复色时间提前。     

A 4-year follow-up study of atopic dermatitis therapy with 0.1% tacrolimus ointment in children and adult patients

Background For the treatment of a chronic disease like atopic dermatitis, sustained tolerability and efficacy of the applied medication are essential. Objectives The present open‐label, noncomparative study was conducted to obtain information on the long‐term safety and efficacy of 0·1% tacrolimus ointment. Methods Patients aged 2 years or older with an affected body surface area of more than 5%, who previously participated in a clinical trial on tacrolimus ointment, were eligible for this study. The treatment area was defined by the investigator at study entry. Both children and adults applied continuously or intermittently 0·1% tacrolimus ointment twice daily during episodes of active disease plus an additional week after remission over a follow‐up period of up to 4 years. Results The intent‐to‐treat population comprised 782 patients, with a median age of 22 years (range 2–72). Patients remained in the study for up to 4 years. Approximately half of the patients discontinued the study prematurely; the median follow‐up was 1422 days. Median tacrolimus ointment use was 31·2 g during the first week; ointment use decreased during the first year and then remained stable for the remainder of the study. The median cumulative tacrolimus use was 271·5 g at month 6, 462·5 g at month 12, 739·9 g at month 24, 1029·3 g at month 36 and 1320·8 g at month 48. Altogether 51·8% of patients discontinued the study prematurely; the main reasons were withdrawal of consent (13·3%), loss to follow‐up (11·3%) and lack of efficacy (9·4%). Adverse events led to study discontinuation in 3·7% of the patients. The most frequent application site events were skin burning and pruritus. These events were most often reported in adult patients during the initial treatment period; prevalence decreased after the first week and remained at a low level throughout the study. Nonapplication site events occurred with stable incidences throughout the study period. In general, calculated daily hazard rates did not indicate an increased risk of adverse events with prolonged treatment. The total affected body surface area decreased substantially upon onset of treatment and efficacy of treatment was maintained until the end of the study with smaller but continuous improvements throughout the follow‐up period. Overall, 75% of the patients and 76% of the investigators rated their satisfaction with the treatment as excellent, very good or good at the end of the study or at the time of premature discontinuation. Conclusions The safety profile of intermittent or continuous long‐term application of 0·1% tacrolimus ointment for up to 4 years was consistent with that which has been established from shorter studies and gave no reason for concern. In addition, 0·1% tacrolimus ointment demonstrated sustained efficacy as reflected by the expression of high satisfaction with treatment by both patients and investigators.     

A comparative study on the use of fractional CO2 laser with tacrolimus or calcipotriol or narrow band ultraviolet‐B in treatment of stable nonsegmental vitiligo

Conventional methods of treatment for vitiligo are often unsatisfactory to the patients and time consuming, new treatment modalities are needed. This study was conducted to evaluate the efficacy and safety of fractional carbon dioxide (CO₂) laser therapy followed by narrow band ultraviolet‐B (NB‐UVB) phototherapy, topical tacrolimus or topical calcipotriol on stable nonsegmental vitiligo. Thirty patients with stable nonsegmental vitiligo were evaluated. All patients were subjected to three sessions of fractional CO₂ laser 1 month apart. Patients were divided into three groups (each group 10 patients). Group (A) treated with tacrolimus ointment twice daily for 3 months, group (B) treated with calcipotriol ointment twice daily for 3 months, and group (C) treated with NB‐UVB twice weekly for 3 months. Outcomes were evaluated by calculating vitiligo area scoring index (VASI) score change, percentage of repigmentation, patient satisfaction, and adverse effects. There was a statistical significant decrease in VASI score after treatment in the three groups. The VASI change and % of regimentation was higher in group (C) treated by laser and NB‐UVB and this was significantly higher than group (B) treated with laser and calcipotriol. Otherwise, there was no statistical significant difference between other treatment groups. In concluion, NB‐UVB phototherapy, topical tacrolimus, or topical calcipotriol in combination with fractional CO₂ laser could be used effectively and safely as an alternative modality for treatment of vitiligo. The combination of fractional CO₂ laser and NB‐UVB was found to be more effective.     

Treatment of vitiligo with narrowband‐UVB (TL01) combined with tacrolimus ointment (0.1%) vs. placebo ointment,a randomized right/left double‐blind comparative study

Background Only a few, small double‐blind clinical trials have been reported for the treatment of vitiligo. Narrowband‐ultraviolet B (NB‐UVB) is an established form of treatment for this condition. Tacrolimus ointment is assumed to have an effect in some patients. Objectives To assess the additive effect of tacrolimus ointment (0.1%) once daily in vitiligo patients treated with NB‐UVB. Methods In a randomized double‐blind trial, patients with stable symmetrical vitiligo were treated half‐side with tacrolimus ointment (0.1%) and half‐side with placebo ointment. Whole body NB‐UVB was given twice or thrice weekly for at least 3 months. As a morphometric device, Visitrak^TM was used to measure the area of the vitiligo target lesions. Results Of 40 patients, 27 had a better effect on the tacrolimus side. The degree of improvement was significantly better on the tacrolimus side (P = 0.005). The median reduction in the target lesion areas was 42.1% on the tacrolimus side and 29% on the placebo side. There was a correlation between the effect and the number of topical tacrolimus applications (P = 0.044), but there was no correlation with the number of UV treatments given; neither any significance of gender, age, skin type, duration of disease, familial occurrence of vitiligo nor presence of other autoimmune disease or atopy was observed. We found a significant reduction in the patients’ subjective disease impact during the treatment period (P < 0.001). Conclusion According to this study, the combination of NB‐UVB and tacrolimus ointment (0.1%) is more effective than UV treatment alone in patients with vitiligo. The effect is tacrolimus total dose‐dependent.     

308 nm准分子激光治疗白癜风及影响疗效的相关因素

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