关节病性银屑病患者阿维A治疗前后血清血管内皮生长因子和金属蛋白酶-9的变化

近年来大量的实验研究揭示，在关节病性银屑病滑膜血管翳形成的过程中有高水平的血管内皮生长因子（vascular endothelial growth factor，VEGF）表达。且与金属蛋白酶（matrix metallopmteinases，MMPs）有关。笔者检测了关节病性银屑病患者经阿维A治疗前、后血清VEGF和MMP-9的动态变化，以期阐明VEGF和MMP-9在关节病性银屑病发病机制中的作用及进一步探讨阿维A治疗关节病性银屑病的机制。     

银屑病患者血小板衍生生长因子—A和胰岛素样生长因子—I受体α的免疫组化研究

研究表明,血小板衍生生长因子(platelet-derivedgrowthfactor,PDGF)可能在银屑病发病过程中起一定的调节作用[1,2]。为对PDGF在银屑病发病过程中的作用有更多了解,我们采用免疫组化研究PDGF-A和胰岛素样生长因子-Ⅰ受体α(insulin-likegrowthfactor-Ⅰre-ceptors-α,IGF-ⅠR-α)在银屑病患者皮损、非皮损和健康人正常皮肤中的表达。一、对象和方法研究对象:静止期寻常性银屑病患者12例,男7例,女5例;年龄31~56岁;病程3~17年。患者取材前3个月内未接受皮质类固醇、免疫抑制剂、PUVA和其它抗银屑病药物治疗。标本取自皮损和皮损周围正…     

阿维A对银屑病患者血清STCP-1,GM-CSF的影响

目的观察阿维A治疗银屑病的疗效及对银屑病患者血清中细胞因子水平的影响。方法分别用酶联免疫吸附法和放射免疫吸附法检测寻常性银屑病各期患者服用阿维A胶囊治疗前后血清STCP-1和GM-CSF的水平并进行PASI评分。结果阿维A治疗寻常性银屑病后治愈11例(31.43%),有效率为82.85%。银屑病患者在治疗前血清STCP-1和GM-CSF的水平均比健康对照组显著升高(P(0.01),同时发现治疗前进行期患者细胞因子水平比静止期高(P(0.01);阿维A治疗后血清STCP-1和GM-CSF水平均显著下降(P(0.05,P(0.01)。患者血清GM-CSF水平与PASI评分呈正相关(r=0.421,P(0.05),STCP-1水平与PASI评分无相关性(r=0.244,P(0.05)。结论阿维A对寻常性银屑病患者有较好的治疗作用,血清STCP-1和GM-CSF在银屑病的发病中有重要意义。     

阿维A对中重度寻常型银屑病患者外周血MCP-4表达水平的影响

目的:检测中重度寻常型银屑病患者阿维A治疗前后血清MCP-4水平的变化。方法:26例中重度寻常型银屑病患者口服阿维A治疗8周。采用ELISA法检测正常对照和银屑病患者治疗前后血清MCP-4的表达水平。结果:寻常型银屑病外周血MCP-4为196.64±35.21 pg/mL,明显高于正常对照组(42.83±9.68 pg/mL),阿维A治疗后血清MCP-4为107.23±21.57 pg/mL,与治疗前相比明显降低(P0.01),但仍高于正常对照组(P0.01)。结论:阿维A可能通过调节外周血MCP-4表达水平发挥治疗银屑病作用。     

阿维A对系统性硬皮病患者血清转化生长因子-β1的影响

系统性硬皮病(systemic sclerosis,SSc)是一种以皮肤及各系统胶原纤维进行性硬化为特征的结缔组织疾病.转化生长因子(tansforming growth factor,TGF)β1在SSc发病中起重要作用.     

银屑胶囊联合阿维A治疗寻常型银屑病患者的疗效及对血清IL-4、IL-10和INF-γ的影响

目的探讨银屑胶囊联合阿维A胶囊治疗寻常型银屑病的疗效及对血清白细胞介素(IL)-4、IL-10和干扰素(INF)-γ的影响。方法 120例患者随机分为治疗组和对照组,对照组60例给予阿维A胶囊20 mg/次,1次/d口服,治疗组给予阿维A胶囊20 mg/次,1次/d口服,联合银屑胶囊1.8 g/次,3次/d口服,2组疗程均为8周,用银屑病皮损面积和严重程度指数评分(PASI)评价疗效,并比较治疗前后患者血清IL-4、IL-10和INF-γ,记录不良反应。结果 2组均有较好的疗效,治疗组优于对照组,治疗后2组患者血清IL-4、IL-10均显著高于治疗前,但治疗组显著高于对照组,2组患者血清INF-γ均显著低于治疗前,且治疗组血清INF-γ低于对照组,治疗组患者眼干、皮肤干燥、鼻出血、毛囊炎、转氨酶升高及血脂升高等不良反应均显著低于对照组。结论银屑胶囊联合阿维A治疗寻常型银屑病不仅高效安全,而且可改变患者血清IL-4、IL-10和INF-γ的水平,值得推广应用。     

阿维A治疗前后对银屑病患者血管内皮生长因子表达的影响

目的 研究阿维A对血管内皮生长因子(VEGF)促银屑病血管生成的调节作用,探讨阿维A治疗银屑病的机制。方法 免疫组化法检测32例银屑病患者经阿维A治疗前后皮损的微血管密度和VEGF蛋白的表达情况。应用双抗体夹心酶联免疫吸附法(ELISA)检测32例银屑病患者经阿维A治疗前后外周血清中VEGF水平。结果 ①银屑病患者经阿维A治疗前皮损VEGF蛋白的表达及微血管密度值显著高于治疗后(P<0.05)和正常人对照组(P<0.001)。②银屑病患者阿维A治疗前的血清VEGF水平高于治疗后(P<0.001)及正常人对照组(P<0.001)。结论 VEGF在银屑病新生血管生成中起重要作用。阿维A可能通过抗新生血管生成的作用来治疗银屑病。     

系统性红斑狼疮血清干扰素诱导蛋白10的检测及其意义

目的:检测系统性红斑狼疮(SLE)患者血清干扰素诱导蛋白10(IP-10)水平,并探讨其临床意义.方法:采用ELISA法检测58例SLE患者及40名正常对照者血清IP-10,比较分析其与SLE病情活动指数(SLEDAI)、肾损害、抗dsDNA、补体C3和白细胞计数的相关性.结果:SLE患者血清IP-10水平明显高于正常对照组(P＜0.01),并且活动期高于静止期(P＜0.01),肾损组高于无肾损组.血清IP-10水平与SLEDAI(P＜0.01)、抗dsDNA抗体滴度对数值呈正相关(P＜0.05),与C3(P＜0.01)、白细胞计数(P＜0.05)呈负相关.结论:检测血清IP-10水平有可能作为狼疮活动的敏感指标之一.     

阿维A治疗寻常型银屑病的成本-效果分析

为评价国产和进口阿维A治疗寻常型银屑病的成本-效果,采用循证医学的方法收集临床资料,应用药物经济学的成本-效果分析法分别对进口和国产阿维A治疗寻常型银屑病的疗效进行评价.国产和进口的阿维A治疗寻常型银屑病的有效率分别为76.36%(70.19%,82.53%)和94.20%(90.18%,98.22%),(P<0.05),成本-效果比(C/E)分别为3.78和31.94,国产和进口阿维A增量成本-效果比值△C/△E为152.46;虽然进口阿维A疗效优于国产组,但成本-效果分析表明,国产阿维A治疗寻常型银屑病更具成本-效果优势.     

阿维A对寻常型银屑病树突状细胞活性的影响

目的:确定阿维A对银屑病患者外周血树突状细胞活性的影响。方法:抽取银屑病患者外周血,分离单个核细胞,体外诱导培养树突状细胞(DCs)。阿维A组加入阿维A(浓度为10 nmol/L)和培养液作用DCs 24 h,对照组仅加培养液。暗视野显微镜下观察阿维A作用前后DCs树突的数量及长度变化。结果:实验组阿维A作用后DCs树突与作用前比较其数量及长度没有明显变化,差异无显著性(P>0.05),对照组DCs的树突数量及长度明显增多变长,差异具有显著性(P<0.05)。结论:阿维A可以明显抑制银屑病患者DCs树突数量的增多及长度的增加,从而抑制DCs免疫学活性,达到治疗银屑病的目的。     

Cutaneous carcinoma in psoriatic patients treated with PUVA

Eight of 216 psoriatic patients treated at The London Hospital with photochemotherapy (PUVA) have developed a total of twenty-five skin carcinomata. The type and site of tumour are discussed with special reference to the importance of PUVA compared with other risk factors. We suggest that a history of previous skin carcinoma, arsenic therapy or radiotherapy are relative contra-indications to PUVA therapy for psoriasis.     

Cutaneous vascular alterations in psoriatic patients treated with cyclosporine

Videocapillaroscopy can be used to assess cutaneous microcirculation modifications in vivo, and therefore allows assessment of variations in the microvascular architecture in psoriatic subjects during treatment. The aim of this study was to observe and quantify the modifications of the superficial capillary bed in psoriatic plaques during treatment with cyclosporin A. Twelve patients with psoriasis vulgaris were treated with an initial dose of 4 mg/kg/day cyclosporin A over a period of 3 months with periodic clinical and capillaroscopic assessments. Clinical resolution of the lesions and a reduction in microcirculatory alterations was observed in 70% of patients, although none returned to a normal capillaroscopic pattern.     

Photochemotherapy for psoriatic patients treated with corticosteroids and methotrexate

The effect of photochemotherapy with oral administration of 8-methoxypsoralen followed by irradiation with UVA (PUVA) was investigated in 34 cases of severe, generalized psoriasis which could be controlled only by systemic administration of corticosteroids and cytotoxic agents. In each case clearing of psoriatic lesions was achieved under PUVA treatment. As expected, the average duration of the initial PUVA treatment period was longer when compared to patient groups not pretreated with corticosteroids and cytotoxic agents. In order to avoid relapses, maintenance treatment was installed after complete healing of psoriatic lesions comprising an average of one PUVA exposures per week. Eighty percent of such treated patients are continuously completely clear; the remaining patient group is 70--90% improved. The side effects, elicited by the previous administration of corticosteroids and/or cytotoxic agents are improved or have resolved under PUVA therapy. The present study indicates, that PUVA treatment of psoriasis is not only an alternative to the use of systemic corticosteroids and cytotoxic agents but is superior to these treatment modalities due to its lack of side effects and its higher effectiveness.     

银屑病患者皮损在阿维A治疗前后角蛋白10、14、17的变化

目的 探讨角蛋白10、14、17（K10、K14、K17）在阿维A治疗前后银屑病皮损中的表达。方法 免疫组化法检测30例中、重度斑块状银屑病患者经阿维A治疗前后皮损中K10、K14、K17的表达情况。并观察患者病情变化与各角蛋白指标含量之间的相互关系。结果 ①银屑病患者治疗前皮损中K14、K17阳性面积率明显增加,而K10阳性面积率下调;阿维A治疗后K14、K17阳性面积率明显降低（P < 0.01）,K10阳性面积率明显增加（P < 0.01）,但与正常人对照组比较差异仍有统计学意义（P < 0.01）。②治疗后患者的PASI评分与治疗前比较显著下降（ P < 0.01）。③治疗前后K17、K14、K10的变化与疾病的过程及严重程度有一定关系。结论 系统应用阿维A可改变银屑病皮损中K14、K17、K10的表达,但改变程度并不总与临床表现的改善程度相一致。