黑素细胞在白癜风中的免疫损伤

有关白癜风病因的各种学说中自身免疫学说得到了越来越多的重视。近期研究发现白癜风皮损中黑素细胞的破坏和消失与患者的体液及细胞免疫作用相关。而黑素细胞在合成黑素的同时具有免疫功能 ,并有可能在自身的免疫破坏过程中起了一定的作用。     

308 nm准分子激光治疗白癜风的现状

白癜风的治疗仍是皮肤科医生面临的一大难题。光疗作为有效、安全的治疗手段,在白癜风治疗中的应用正在逐步推广。308nm准分子激光治疗白癜风快速有效、不良反应少。联合其他治疗方法可提高紫外线抵抗区的疗效。为此,综述308nm准分子激光治疗白癜风的新进展,以供临床参考。     

准分子激光治疗白癜风的临床疗效与安全性研究

Objective To assess the efficacy and safety of 308 nm excimer laser in the treatment of different types of vitiligo at different stages. Methods A total of 128 patients with vitiligo, who had 317 depigmented patches, were recruited in this study and treated with 308 nm excimer laser once a week for at least 8 weeks. The degree of repigmentation was evaluated and adverse effects were recorded at the end of every treatment and last treatment. Results All patients received efficacy and safety evaluation. Of the 317 patches, 97.5% achieved repigmentation at different degrees, 71.8% got more than 25% repigmentation, and 50.8% got more than 75% repigmentation. The degree of repigmentation increased with the number of treatments. A better response was observed in the lesions on the face and neck than those on the mink and limbs, and in short-duration (<1 year) lesions than in long-duration (≥1 year) lesions. And the lesions on extremities and mueosa showed a poorer response compared with those at other sites. There was no statistical difference in clinical efficacy between active vitiligo and stable vitiligo, or between adults and children. Moreover, the treatment was well tolerated. Conclusion 308 nm excimer laser is effective in the treatment of vitiligo with rapid onset, favorable tolerability and few adverse effects.     

加巴喷丁胶囊治疗疱疹后神经痛的多中心临床观察

Objective To observe the clinical efficacy and safety of gahapentin in the treatment of postherpetic neuralgia. Methods A multicenter, randomized, double-blind, placebo-controlled, parallel design, 6-week study was performed. Patients with postherpetic neuralgia were recruited into this study and randomly divided into two groups to receive gabapentin or placebo 1800 mg daily in three divided doses with a forced titration schedule, respectively. The primary efficacy measure was change in the pain score based on a visual analogue scale from baseline to the final week of therapy, and secondary measure was the improvement in sleep quality scored on a 5-point severity scale. Efficacy and safety evaluation was performed at baseline, and 1, 3, and 6 weeks atter the treatment. Results One hundred and forty-one patients were recruited in four clinical centers, and 125 patients completed the trial, of whom 66 were in the treatment group and 59 in the control group. An improvement was observed in both pain scores and sleep scores on week 1, 3 and 6 in both two groups, and the improvement was greater in gabapentin-treated group than that in the control group. The response rate was 29.58% and 57.75%, respectively in gabapentin-treated group on week 1 and 3, com-pared to 13.04% and 40.58%, respectively, in the control group (t = 5.94, 4.12, respectively, both P ＜0.05).Gabapentin was well tolerated, and the most common adverse events were dizziness, vertigo, somnolence and transient abnormality of hepatic function. Conclusion Gabapentin could markedly reduce pain intensity and improve sleep quality with a low incidence of adverse events in patients with postherpetic neuralgia.     

吡美莫司乳膏治疗特应性皮炎多中心、随机双盲、平行对照研究

目的评价1％吡美莫司乳膏治疗特应性皮炎的安全性和有效性。方法采用多中心、随机双盲、赋形剂平行对照的临床研究。特应性皮炎患者被随机分配至治疗组和安慰剂组，分别外用1％吡美莫司乳膏或赋形剂，每日2次，疗程4周，于治疗前（基线）及治疗后第1、2、4周各访视1次。主要疗效指标为研究者总体评估（IGA）评分，次要疗效指标包括湿疹面积与严重度指数（EASI）、瘙痒程度评分及受试者胪理者主观评分等。结果7个中心共有336例儿童和成人轻、中度特应性皮炎患者纳入意向治疗分析（ITT）。治疗结束时，1％吡美莫司乳膏组总体评估的治疗成功率为31．55％，明显高于赋形剂组的18．45％（P=0．0046）。其他疗效指标在治疗后第1、2．4周1％吡美莫司乳膏组均明显优于赋形剂组（P〈0．05）。1％吡美莫司乳膏组药物相关不良反应发生率为19．64％，赋形剂组为24．40％，主要表现为红斑，红斑加重、疼痛、瘙痒，瘙痒加重、烧灼感和毛囊炎等。结论1％吡美莫司乳膏对治疗儿童和成人轻、中度特应性皮炎疗效确切。安全性较好。     

白塞综合征128例临床分析

目的:总结白塞综合征的临床特点,提高对白塞综合征的认识.方法:对收集的128例白塞综合征患者的临床资料进行回顾性分析,对其临床表现、实验室检查、男女间的差异进行比较.结果:128例患者中男女比例约1.5:1,发病年龄多为20～39岁(78.3%).平均发病年龄(32.0±12.1)岁,病程1～22 年,平均病程5 年.其中不完全型80例(62.5%),完全型48例(37.5%).口腔溃疡是最常见的临床表现(128 例,100%),其次为皮肤损害(115 例,89.8%),生殖器溃疡(92 例,71.9%),针刺反应阳性(70例,54.7%),眼部损害(38 例,29.7%).人白细胞抗原(HLA)-B51 阳性率为29.5%(18/61).口腔溃疡为最常见的首发表现(91例,71.1%),其次为皮肤损害(69 例,53.9%),外阴溃疡(61 例,30.9%),眼部损害(15例,11.7%).男女间在发病率、皮损类型、眼部损害、神经系统损害及相关实验室检查差异显著.结论:白塞综合征累及多系统,临床表现多变,男女间差异明显.     

白介素2基因佐剂协同HSV-2多表位复合DNA疫苗诱导小鼠免疫应答

目的 研究白介素2(IL-2)cDNA协同HSV-2多表位复合DNA疫苗免疫对小鼠体液和细胞免疫应答的影响.方法 利用真核表达质粒pcDNA3.1分别构建HSV-2糖蛋白gD、gB、gC和早期表达蛋白ICP27的多表位复合DNA疫苗HV-pcDNA3.1和IL-2的真核表达质粒IL-2-pcDNA3.1.15只C57/BL6小鼠分为3组,分别接受pcDNA3.1空载体注射、HV-pcDNA3.1单独免疫或HV-pcDNA3.1及IL-2-pcDNA3.1联合免疫.共免疫2次,间隔2周.末次免疫3周后.ELISA法检测小鼠血清HSV-2特异性IgG、IL-2和IFN-γ,淋巴细胞特异性增殖反应和乳酸脱氢酶法检测杀伤性T淋巴细胞(CTL)功能.结果 与HV-pcDNA3.1单独免疫组相比.IL-2-pcDNA3.1的协同免疫可以提高小鼠血清中和IFN-γ表达(1956.19±219.60ng/L,P<0.05),增强淋巴细胞特异性增殖反应(促细胞增殖率为2.75%±0.26%,P<0.05)和CTL活性(47.91%±15.09%,P<0.05).小鼠血清HSV-2特异性IL-2水平在协同免疫组为(1421.16±220.98)ng/L,HV-pcDNA3.1单独免疫组为(1246.84±157.02)ng/L.两组间差异无统计学意义.结论 IL-2cDNA的协同免疫可以显著提高HSV-2多表位复合DNA疫苗诱导的细胞免疫应答水平.     

加巴喷丁胶囊治疗疱疹后神经痛的多中心临床观察

目的 观察加巴喷丁治疗疱疹后神经痛的临床疗效和安全性.方法 多中心、随机双盲、安慰剂对照、平行设计临床试验.疱疹后神经痛患者随机分为治疗组和对照组,两组患者分别口服加巴喷丁胶囊1800 mg/d或安慰剂胶囊,总共接受6周的药物治疗.于治疗前及治疗后第1、3、6周各随访1次,进行疗效和安全性评价.以视觉模拟评分法进行疱疹后神经痛的疼痛评分作为主要观察指标,以5点严重程度评分方法进行睡眠质量评分作为次要观察指标.结果 4个中心共人选141例疱疹后神经痛患者,125例完成试验,其中试验组66例,对照组59例.与用药前相比,用药后1周、3周和6周时,两组在疼痛严重程度、睡眠质量方面均有不同程度改善;试验组在用药后1周、3周改善更为明显.用药后第1周和第3周试验组的有效率分别为29.58%和57.75%,对照组分别为13.04%和40.58%,试验组高于对照组,两组比较,差异均有统计学意义(X2CMH分别为5.94,4.12,P＜0.05).加巴喷丁有较好的耐受性,不良反应主要表现为头晕、头昏、嗜睡和转氨酶升高等.结论 加巴喷丁胶囊治疗疱疹后神经痛,能改善患者疼痛严重程度和睡眠质量,不良反应发生率低.     

准分子激光治疗白癜风的临床疗效与安全性研究

Objective To assess the efficacy and safety of 308 nm excimer laser in the treatment of different types of vitiligo at different stages. Methods A total of 128 patients with vitiligo, who had 317 depigmented patches, were recruited in this study and treated with 308 nm excimer laser once a week for at least 8 weeks. The degree of repigmentation was evaluated and adverse effects were recorded at the end of every treatment and last treatment. Results All patients received efficacy and safety evaluation. Of the 317 patches, 97.5% achieved repigmentation at different degrees, 71.8% got more than 25% repigmentation, and 50.8% got more than 75% repigmentation. The degree of repigmentation increased with the number of treatments. A better response was observed in the lesions on the face and neck than those on the mink and limbs, and in short-duration (<1 year) lesions than in long-duration (≥1 year) lesions. And the lesions on extremities and mueosa showed a poorer response compared with those at other sites. There was no statistical difference in clinical efficacy between active vitiligo and stable vitiligo, or between adults and children. Moreover, the treatment was well tolerated. Conclusion 308 nm excimer laser is effective in the treatment of vitiligo with rapid onset, favorable tolerability and few adverse effects.     

准分子激光治疗白癜风的临床疗效与安全性研究

目的 探讨308 nm准分子激光治疗不同类型及病期的白癜风的疗效和不良反应.方法 对128例白癜风患者的317处皮损进行局部照射,每周1次,8次为1个疗程.每个疗程结束及治疗结束后对色素恢复程度进行评估,并记录不良反应.结果 共治疗皮损317片,总体应答率为97.5%,有效率为71.3%,显效率为50.8%.色素恢复程度随着治疗次数增加而增加.面颈部疗效优于躯干四肢,躯干四肢优于肢端部位.短病程(<1年)的白癜风皮损疗效优于长病程(≥1年)的皮损.成人和儿童、活动期和稳定期的皮损疗效无明显差异.患者耐受性较好.结论 308 nm准分子激光治疗白癜风起效快,疗效及依从性好,不良反应少.