阿维A联合NB-UVB与卡泊三醇治疗银屑病及对IL-l7、22、23的影响

目的 探讨应用阿维A联合NB-UVB与卡泊三醇治疗银屑病疗效及对银屑病患者外周血血清中IL-17、IL-22、IL-23水平的影响。方法 将108例患有重度的寻常型斑块状银屑病的病人,随机平均分成为A、B、C三组:其中A组病人治疗时采取窄谱中波紫外线(NB-UVB)全身照射的方法,每周3次;B组于每日早晚清洁患处皮损后外用卡泊三醇软膏;C组病人治疗时则联合应用窄谱中波紫外线(NB-UVB)光疗及卡泊三醇软膏的方法。参与实验的患者治疗时均口服阿维A胶囊,整个实验的治疗疗程为8周。观察三组患者的临床疗效并进行PASI评分以及DLQI评分比较。检测治疗前后患者外周血血清中IL-17、IL-22、IL-23表达的变化情况。结果 应用阿维A单独或同时联合 NB-UVB光疗及外用卡泊三醇软膏均能够使得患者的PASI评分、DLQI评分、外周血血清中的相关炎症因子IL-l7、IL-22和IL-23水平均较治疗前有明显降低,且口服阿维A同时联合外用卡泊三醇软膏和 NB-UVB光疗治疗重度寻常型斑块状银屑病能够达到更好、更显著的近期治疗效果,该组患者的PASI评分和DLQI评分较阿维A单独联合NB-UVB光疗或卡泊三醇软膏治疗降低更显著,有更加明显的治疗效果,患者外周血血清中相关炎症因子IL-l7、IL-22和IL-23水平降低较应用阿维A单独联合NB-UVB光疗或卡泊三醇软膏的治疗方案时更明显。此种治疗方案能够使得患者的近期治疗效果更理想,从而达到改善提高病人生活质量的目的。结论 阿维A联合NB-UVB光疗和卡泊三醇软膏治疗重度寻常型斑块状银屑病患者疗效更显著,可以作为治疗重度寻常型斑块状银屑病的常规治疗方案;阿维A联合NB-UVB光疗和卡泊三醇软膏治疗重度寻常型斑块状银屑病外周血血清中IL-17、IL-22和IL-23水平降低更明显;患者外周血血清中IL-17、IL-22、IL-23水平的变化作为实验室治疗效果的一种评价指标。

The influence of Acitretin combinating with NB-UVB and calcipotriol on patients with psoriasis and expression of IL-17 ,IL-22 ,IL-23

Objective To discuss the influence of Acitretin combinating with NB-UVB and calcipotriol on patients with psoriasis and expression of IL-17,IL-22,IL-23.Methods 108 cases of complete information on patients with severe plaque psoriasis vulgaris, according to the random number table were divided into A,B,C three groups:Group A take NB-UVB method of total body irradiation for treatment three times a week;after Group B in the morning and evening after cleaning skin lesions topical calcipotriol ointment; Group C together for joint A and B treatment,all of them were with low-dose oral acitretin.The whole treatment course was eight weeks.Observed and compared the clinical efficacy of the three groups of patients,PASI and DLQI score, tested the changes of levels of IL-17,IL-22,IL-23 in patients with severe plaque psoriasis vulgaris in peripheral blood serum.Results Acitretin combined with NB-UVB and/or calcipotriol ointment treatment of severe plaque psoriasis vulgaris can cause decrease of PASI score,DLQI score and levels of their inflammatory cytokines IL-17,IL-22,IL-23 in patients with severe plaque psoriasis vulgaris in peripheral blood serum were lower than before therapy.And the level of reduce PASI score,DLQI score,IL-17,IL-22,IL-23 was most notable with the patients were treated by Acitretin combinate with NB-UVB irradiation efficacy and calcipotriol ointment.The clinical treatment time can be shortened,and enhance the patient's resistance to improve the quality of life of patients.Conclusions Effects of Acitretin combined with NB-UVB irradiation and calcipotriol treated the patients with severe plaque psoriasis vulgaris were most significantly. Acitretin combined with NB- UVB and calcipotriol can be used to treat severe plaque psoriasis vulgaris and should be popularized.The level of IL-17,IL-22,IL-23 decreased more obviously in the treatment of Acitretin combined with NB- UVB and calcipotriol. The level of IL-17,IL-22,IL-23 in patients' eripheral blood serum can be used to evaluate the severity of psoriasis and therapeutic effect.