他克莫司软膏治疗白癜风的临床疗效及对患者T淋巴细胞水平的影响

目的:探讨他克莫司软膏治疗白癜风的临床疗效及对患者T淋巴细胞水平的影响。方法:将80例白癜风患者随机分为对照组和观察组,各40例。对照组给予窄谱中波紫外线照射治疗,观察组在对照组治疗基础上给予0.1%他克莫司软膏外涂。治疗1个月后评估疗效,均随访12个月。治疗后,采用酶联免疫吸附试验检测患者白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、趋化因子-9(CXCL-9)及细胞间黏附分子1(ICAM-1)水平;采用流式细胞仪检测患者T淋巴细胞CD3+、CD4+、CD8+、CD4+/CD8+水平。比较两组皮损面积、首次复色时间、色素积分、炎症因子水平、T淋巴细胞水平、不良反应发生率及复发率。结果:治疗1个月后,观察组皮损面积、色素积分及首次复色时间均小(短)于对照组(t值分别为11.49、16.89、19.30,P值均<0.05),治愈率高于对照组(2=25.07,P<0.05)。观察组与对照组治疗过程中瘙痒、水疱、瘢痕发生率比较,差异均无统计学意义(P值均>0.05)。观察组治疗后6个月、12个月复发率均低于对照组(2值分别为12.62、14.83,P值均<0.01)。治疗后1个月,观察组炎症因子IL-6、TNF-α、CXCL-9及ICAM-1水平均低于对照组(t值分别为48.69、12.83、18.42、35.52,P值均<0.05),T淋巴细胞CD3+、CD4+及CD4+/CD8+百分比高于对照组(t值分别为7.91、5.12、2.73,P值均<0.05),CD8+百分比低于对照组(t=3.96,P<0.05)。结论:他克莫司软膏治疗白癜风能减小皮损面积,缩短首次复色时间,降低复发率,有助于降低炎症因子水平,改善T淋巴细胞水平,且药物安全性较高,值得推广应用。

Efficacy of tacrolimus ointment for vitiligo and its effect on T cell levels

Objective:To investigate the efficacy of tacrolimus ointment for vitiligo and its effect on T cell levels. Methods:Eighty patients with vitiligo were randomly divided into the control group ( n =40) and the treatment group ( n =40). The control group was treated with narrow-band ultraviolet radiation, while the treatment group was treated with both 0.1% tacrolimus ointment and narrow-band ultraviolet radiation. Therapeutic efficacy was evaluated after1-month treatment. All patients were follow-up for12 months. The incidence of adverse reactions and recurrence rate were also assessed. In addition, circulating levels of interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), chemokine-9 (CXCL- 9) and intercellular adhesion molecules (ICAM-1) were measured by ELISA assay. Flow cytometry was used to measure CD3 +, CD4 +, CD8 +, CD4 +/CD8 + cells. The lesion area, time of repigmentation, pigmentation score, levels of cytokines and inflammatory markers, and T cell levels were compared between the two groups. Results: Following1-month treatment, patients in the treatment group displayed marked improvements in lesion area and pigmentation score, along with shorter time of repigmentation in comparison to the controls ( P <0.05 for all). The cure rate was higher in the treatment group than in the controls. The incidence of itching, blisters and scars did not differ between the two groups ( P >0.05). The 6-month and 12-month recurrence rate was lower in the treatment group than in the controls ( P <0.01). Moreover, the circulating levels of IL-6, TNF-α, CXCL-9 and ICAM-1 were lower in the treatment group than in the controls ( P <0.05 for all). Additionally, the ratios of CD3 +, CD4 + and CD4 + to CD8 + T cells were higher ( P <0.05), while proportion of CD8 + T cells was lower in the treatment group than in the controls. Conclusions: Tacrolimus ointment can improve vitiligo and lower levels of circulating cytokines, while improving the balance of circulating T cells, with lower recurrence rate.