窄谱中波紫外线加中药治疗寻常性银屑病疗效观察

目的比较窄谱中波紫外线（NB-UVB）加中药、中药、NB-UVB3种方法治疗寻常性银屑病的疗效,探讨一种提高寻常性银屑病治愈率的同时有效延长缓解期的方法：方法分别采用NB-UVB加中药、中药、NB-UVB治疗寻常性银屑病各35例,并随访2年。结果NB-UVB加中药组治愈30例,2年复发2例;NB—UVB组治愈23例,2年复发12例;中药组治愈14例,2年复发2例,结论NB-UVB加中药治疗寻常性银屑病既提高治愈率又有效延长缓解期。     

长期缓解的银屑病76例临床分析

寻常性银屑病易诊断,难治疗.因此,如何延长缓解期,减少复发,成为当前研究的课题.为评价寻常性银屑病的长期疗效,我们从1996年起对寻常性银屑病临床治愈、皮损消退后3年以上未复发的76例进行了随访、分析,现将结果报道如下.     

窄谱中波紫外线治疗寻常型银屑病的临床观察

目的:观察311 nm窄谱中波紫外线(NB-UVB)不同照射频率以及维持照射治疗寻常型银屑病的疗效及安全性。方法:将63例患者随机分为每周2次组和每周3次+维持治疗组两组,以银屑病皮损面积和严重度指数(PASI)评价疗效,以Kaplan-Meter生存曲线分析NB-UVB维持照射治疗对银屑病缓解期的影响。结果:两组患者PASI评分较治疗前均有明显改善(P0.001),每周3次治疗起效更快;每周3次、每周2次治疗结束时,两组的平均累积剂量、治疗次数无显著差异,但每周3次治疗获得缓解所需的时间却明显少于后者(P0.01);后续的NB-UVB维持照射治疗对于患者1年后的复发率影响明显,两组患者处于缓解期的可能性之间差异有统计学意义(P0.05)。结论:NB-UVB治疗寻常型银屑病疗效好、不良反应小;每周3次照射方案在不增加潜在风险的同时,能更快地获得满意疗效;对已取得满意疗效的银屑病患者采用维持治疗有助于延长缓解期。     

寻常型银屑病复发相关因素分析及自我管理干预研究

目的:明确寻常型银屑病相关复发因素,建立科学有效的自我管理模式.方法:收集2017年3月至2018年12月皮肤科门诊就诊的寻常型银屑病复诊患者,填写调查问卷,通过Logistic回归法分析相关影响因素,根据影响因素制定个体化健康教育处方.将复诊的患者随机分为对照组和干预组,分别实施常规健康教育和个体化健康教育处方的临床...     

白芍总苷对银屑病患者皮损中IL-17A表达的影响

目的:评价白芍总苷对轻、中度寻常型银屑病患者皮损区IL- 17A表达的影响.方法:免疫组化法检测30例寻常型银屑病患者经白芍总苷治疗前后及健康对照组皮损中IL- 17A的表达.结果:寻常型银屑病患者皮损中IL- 17A的表达较健康对照组显著升高,白芍总苷治疗后皮损中IL-17A表达较治疗前显著降低(P＜0.05);治疗前、后患者皮损中IL- 17A的表达与银屑病面积和严重程度(P ASI)评分呈正相关.结论:白芍总苷可能部分通过调节寻常型银屑病皮损中IL- 17A的表达发挥治疗作用.     

补骨脂素长波紫外线和窄谱中波紫外线治疗寻常性银屑病临床疗效观察

目的:观察补骨脂素长波紫外线(PUVA)和窄谱中波紫外线(NB-UVB)治疗寻常性银屑病的临床疗效及其影响因素。方法:分别采用PUVA和311nmNB-UVB照射治疗146例寻常性银屑病患者,并以银屑病面积和严重度指数(PASI)评价疗效,分析照射剂量等对疗效和复发的影响。结果:NB-UVB治疗寻常性银屑病的疗效与PUVA相当,NB-UVB组患者的治疗时间明显短于PUVA组,NB-UVB组患者1年内复发率高于PUVA组。结论:NB-UVB治疗寻常性银屑病与PUVA相比,不良反应较少,起效较快。     

沙利度胺治疗中重度寻常型银屑病的疗效评价及对患者血清VEGF和bFGF的影响

目的:评价沙利度胺治疗中重度寻常型银屑病的疗效并明确对血清血管内皮生长因子(VEGF)和碱性成纤维细胞生长因子(bFGF)的影响。方法:30例中重度寻常型银屑病患者口服沙利度胺100 mg/次,每日2次,治疗8周。治疗前后采用银屑病皮损面积和严重程度指数评分标准(PASI)进行疗效评定。采用酶联免疫吸附试验(ELISA)测定患者治疗前后血清VEGF和bFGF水平。结果:30例中重度寻常银屑病患者有效率为60.00%;治疗后血清VEGF和bFGF水平明显低于治疗前(P0.01);银屑病患者血清VEGF、bFGF水平与PASI评分呈正相关(均P0.01)。结论:沙利度胺治疗中重度寻常型银屑病有一定疗效,其作用机制可能与抑制血清VEGF和bFGF表达有关。     

阿维A联合窄谱中波紫外线照射治疗寻常型银屑病疗效观察

目的:观察阿维A联合窄谱中波紫外线(NB-uVB)照射治疗寻常型银屑病的临床疗效及影响因素.方法:单独采用NB-uVB照射或联合口服阿维A治疗银屑病70例,并以银屑病面积和严重指数(PAsI)评价疗效,分析性别、皮肤类型、临床亚型及分期对疗效的影响.结果:窄谱中波紫外线照射治疗银屑病有效,联合口服阿维A后疗效可显著提高,缩短疗程,疗效相关因素分析表明,进行期优于静止期(P＜0.05),点滴型优于斑块型(P＜0.05),Ⅲ型皮肤优于Ⅳ型皮肤(P＜0.05),但男性略优于女性(P＞0.05).结论:NB-uVB照射治疗寻常型银屑病疗效好,不良反应小,结合口服阿维A能显著增加疗效,其疗效可能与寻常型银屑病亚型、分期及患者皮肤类型有关.     

复方甘草酸苷辅助治疗寻常型银屑病疗效观察

目的:探讨复方甘草酸苷辅助治疗进行期寻常型银屑病的临床疗效。方法:将进行期寻常型银屑病患者96例随机分为治疗组与对照组各48例,对照组口服复方氨肽素片、转移因子胶囊,同时外搽艾洛松软膏;治疗组在对照组治疗的基础上,同时静脉注射复方甘草酸苷20 mL,每日1次,共四周。结果:治疗组治愈10例,显效24例,有效率为70.83%;对照组治愈4例,显效16例,有效率为41.67%,两组差异有统计学意义(χ2=5.83,P<0.05)。结论:复方甘草酸苷辅助治疗进行期寻常型银屑病效果确切。     

寻常性银屑病患者并发代谢综合征影响因素的Logistic回归分析

目的探讨寻常性银屑病患者发生代谢综合征的相关影响因素。方法对202例确诊为寻常性银屑病的门诊患者进行问卷调查、体格及实验室检查,对寻常性银屑病患者发生代谢综合征的相关因素进行Logistic回归分析。结果年龄大、A型性格、不吃早餐、饮酒是寻常性银屑病患者并发代谢综合征的独立危险因素。结论积极调整患者心态,减轻精神压力,改善生活方式,可望降低和预防寻常性银屑病患者代谢综合征的发生。     

Balneotherapy with Chinese herbal medicine prolongs the remission period in patients with psoriasis vulgaris

This study aimed to evaluate whether the supplementary balneotherapy with Chinese herbal medicine (CHM) could facilitate the treatment of psoriasis vulgaris and thus be beneficial for long‐term remission from the symptoms. Two hundred psoriasis vulgaris patients with moderate‐to‐severe plaque psoriasis from January 2013 to June 2014 were evenly divided into two groups: the consolidated therapy group (CTG) and unconsolidated therapy group (UTG); the remission period of the two groups was compared. There was no significant difference in Psoriasis Area Severity Index (PASI) score between the two groups at the beginning and the end of the treatment. However, the average remission time in CTG was 10.99 months, which was significantly longer than that of 7.94 months in UTG (P = .001). After a correction of age, course of disease, skin type as well as PASI baseline value using a COX model, we found that the risk of recurrence of psoriasis vulgaris in UTG was higher than that in the CTG (P < .001). No adverse reactions were discovered when combing the two treatments together. The combined treatment of CHM balneotherapy and narrowband ultraviolet B could significantly prolong the remission time in patients with psoriasis vulgaris.     

银屑病患者抑郁和焦虑的调查及其对共患病的影响

目的：研究银屑病患者抑郁和焦虑的状况及其对共患病的影响。方法：采用一般情况问卷（自行设计）及抑郁自评量表(SDS)、焦虑自评量表(SAS)对来我院就诊的184例银屑病患者进行调查及评定。结果：184例患者中,合并抑郁或焦虑的银屑病患者113例（61.41%）。合并抑郁或焦虑的银屑病患者与不合并抑郁或焦虑相比发生心血管疾病、脑血管疾病、糖尿病、高血压和高脂血症的比例更高。结论：抑郁或焦虑是银屑病患者发生心血管疾病、脑血管疾病、糖尿病、高血压、高脂血症的独立危险因素。     

特殊类型银屑病伴发高尿酸血症相关因素分析

目的:探讨特殊型银屑病伴发高尿酸血症的相关因素。方法:对117例红皮病型、泛发性脓疱型或/及关节病型银屑病患者的临床资料进行回顾性分析;根据尿酸代谢过程、影响因素、银屑病的临床表现等确定分析指标15项,对高尿酸血症组、正常组间各指标先后进行单因素分析及多因素Logistic回归分析;同时分析特殊用药、病情演变与患者血尿酸水平变化间的关系。结果:特殊类型银屑病伴高尿酸血症发生率为31.62%;高尿酸血症组与正常组比较,性别、红皮病型损害、泛发性脓疱型损害及血甘油三酯增高间的差异均有统计学意义(P<0.05);红皮病型损害、男性、甘油三酯增高、泛发性脓疱型损害是影响高尿酸血症发生的重要因素,其相对危险度(RR)依次为8.93、6.83、2.86、0.31。结论:特殊型银屑病伴发高尿酸血症可能与性别、红皮病型损害、泛发性脓疱型损害、甘油三酯增高及特殊用药有关。     

Alefacept therapy produces remission for patients with chronic plaque psoriasis

BACKGROUND: Alefacept, human LFA-3/IgG1 fusion protein, is a novel biological agent currently being developed for the treatment of chronic plaque psoriasis. Alefacept selectively reduces the memory-effector T cells that have been implicated in the pathogenesis of the disease; as a result, alefacept is classified as a therapy that induces remission (so-called 'remittive' therapy). In a previously published randomized, placebo-controlled phase II study of intravenous alefacept in 229 patients with chronic plaque psoriasis, clinical improvement was observed during dosing as well as in the postdosing follow-up period. OBJECTIVES: To assess the remission period following alefacept therapy. METHODS: The time before re-treatment was required was measured in patients who were 'clear' or 'almost clear' of disease according to a physician global assessment at the end of the follow-up phase. RESULTS: In these patients, responses were sustained for a median of 10 months, and for up to 18 months. No patient reported disease rebound after cessation of alefacept. CONCLUSIONS: Alefacept is a biological agent for the treatment of chronic plaque psoriasis that provides disease-free intervals and time off drug therapy.     

Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy

OBJECTIVE: To assess whether psychological distress affects treatment outcome in psoriasis. DESIGN: Cohort study of patients with psoriasis receiving psoralen-UV-A (PUVA) photochemotherapy. SETTING: Two university hospital dermatology departments. PATIENTS: One hundred twelve patients with chronic plaque psoriasis. MAIN OUTCOME MEASURES: We assessed clinical severity of psoriasis, psychological distress, and other potential confounders of treatment outcome such as skin phototype, family history of psoriasis, and alcohol intake before starting PUVA therapy. Clinical severity of disease and response to therapy were assessed at every fourth appointment. RESULTS: Pathological or high-level worry was the only significant (P =.01) predictor of time taken for PUVA to clear psoriasis. Event curves of time to clearance significantly differed between high- and low-level worry groups (log rank test, 6.64; df = 1; P =.01). Patients in the high-level worry group cleared with PUVA treatment at a rate 1.8 times slower than that of the low-level worry group (ExpB = 1.81; 95% confidence interval, 1.13-2.90). Fiftieth percentile time to clearance of psoriasis in the high- and low-level worry groups showed a median difference of 19 days. CONCLUSIONS: Psychological distress, in the form of excessive worrying, has a significant and detrimental affect on treatment outcome in patients with psoriasis. Patients with psoriasis who are classified as high-level worriers may benefit from adjunctive psychological intervention before and during treatment. These findings provide further evidence of the existence of a brain-skin axis.     

A comparative study of pediatric onset psoriasis with adult onset psoriasis

Psoriasis in childhood is not uncommon. We report data collected from 223 pediatric onset and 484 adult onset psoriasis patients. In the pediatric onset psoriasis patients (POPPs), prevalence of family history was 68.2% compared to 54% in the adult onset psoriasis patients (AOPPs). Also we noticed that exacerbation of psoriasis induced by precipitating factors such as stress (50.4% in POPPs, 42. 7% in AOPPs), pharyngitis (27.9% in POPPs, 12.2% in AOPPs), and trauma (49.6% in POPPs and 38.9% in AOPPs) were more frequent in POPPs. Our data show that the frequency of spontaneous remission in POPPs was 35.3% compared to 24.3% in AOPPs. A disfiguring skin disease in childhood may have profound emotional effects. Childhood psoriasis needs special attention. To achieve a prolonged remission it is essential that children with psoriasis and their parents have an understanding of the exogenous and endogenous factors responsible for the increased morbidity of psoriasis.     

HLA-A26等位基因与银屑病环境危险因素的交互作用

目的：研究银屑病HLA－A26等位基因与环境危险因素之间的交互作用。方法：采用病例对照研究方法，调查190例银屑病患者及同一地区的健康对照191例，用多聚酶链反应－序列特异性引物（PCR－SSP）方法进行HLA－A26等位基因检测，对银屑病的环境危险因素及与HLA－A等位基因间交互作用进行研究。结果：（1）受潮、感染、外伤、嗜酒、吸烟、食鱼虾、药物和精神紧张均为银屑病的环境危险因素。（2）与正常对照组相比，HLA－A26等位基因与银屑病呈显著正相关（P＜0．001）。（3）HLA－A26等位基因与受潮、嗜酒和食鱼虾存在显著交互作用。结论：HLA－A26等位基因似能增加受潮、嗜酒和食鱼虾发生银屑病的易患性。     

Framingham Risk Score underestimates cardiovascular disease risk in severe psoriatic patients: Implications in cardiovascular risk factors management and primary prevention of cardiovascular disease

Severe psoriasis has been associated with increase cardiovascular mortality, due to a higher prevalence of traditional cardiovascular risk factors and premature atherosclerosis, as a consequence of its systemic inflammation. Recently, it has been estimated that severe psoriasis may confer an increased 6.2% on long‐term risk of cardiovascular disease based on Framingham Risk Score, which can have practical implications in the treatment of cardiovascular risk factors and primary prevention of cardiovascular disease, as treatment guidelines account for the risk of cardiovascular disease in treatment goals. The aim of this study was to analyze the influence of the attributable risk of severe psoriasis on long‐term risk of cardiovascular disease and its implication on the correct treatment of cardiovascular risk factors and primary prevention of cardiovascular disease on a real‐world cohort of patients. One hundred severe psoriasis patients without psoriatic arthritis or previous cardiovascular disease were evaluated and it was found that more than half of the patients were reclassified to a higher cardiovascular risk category with important clinical implications on the correct management of their cardiovascular risk factors and primary prevention of cardiovascular disease, as a considerable proportion of patients with hypertension, hypercholesterolemia and coronary heart disease equivalent risk were not being correctly managed.     

Initial photochemotherapy of psoriasis with orally administered 8-methoxypsoralen and longwave ultraviolet light ''PUVA)

One hundred and seven patients with psoriasis underwent initial PUVA therapy. Complete clearance was obtained in 52.3% of the patients, incomplete in 40.2% while 7.5% of the patients did not respond at all. The non-responders to the regular PUVA treatment regime (0.5 mg 8-MOP/kg body-weight) were given an increased 8-MOP (8-methoxypsoralen) dose schedule (0.6 mg 8-MOP/kg body weight) and in 90.9% of these patients their lesions cleared after 35 PUVA exposures. However, a small percentage (9.1%) of the non-responders to the normal dose schedule did not want to continue the increased 8-MOP dose schedule because of persistent nausea. For this reason they were given regular PUVA therapy and they reacted well, but only after fifty-five exposures. Irrespective of the complete or incomplete clearance of psoriasis the patients remained in remission for a mean period of about 5 1/2 months. During the remission period the patients were advised to use a tar preparation or topical corticosteroids in the event of minor exacerbations.