窄谱中波紫外线联合卡泊三醇治疗银屑病的效果及相应血清学指标的分析-现代医学

窄谱中波紫外线联合卡泊三醇治疗银屑病的效果及相应血清学指标的分析

单位：1. 徐州医科大学附属医院皮肤性病科, 江苏徐州 221002;
2. 徐州医科大学麻醉学重点实验室, 江苏徐州 221002

关键词：寻常型银屑病窄谱中波紫外线卡泊三醇 1 25二羟维生素D₃ 白细胞介素-37

分类号：R758.63

出版年·卷·期（页码）：2021·49·第一期（83-87）

摘要：

目的： 评价窄谱中波紫外线（narrow-band ultraviolet B，NB-UVB）联合卡泊三醇治疗寻常型银屑病（psoriasis vulgaris，PV）的临床疗效，分析治疗前后血清1，25（OH）₂D₃、IL-37的表达变化及意义，探讨PV的发病和治疗机制。方法： 对35例中重度PV患者（A组）采用NB-UVB联合卡泊三醇软膏治疗12周，以银屑病面积、严重程度指数（psoriasis area and severity index，PASI）和视觉模拟评分（VAS）评价疗效，检测其和35例健康志愿者（B组）血清1，25（OH）₂D₃、IL-37、IFN-γ的水平，并分析与PASI评分的相关性。结果： A组治疗后的PASI评分、VAS、IL-37水平和IFN-γ水平均显著降低（P<0.01）。A组血清1，25（OH）₂D₃水平较B组低（P<0.01）；在治疗后与B组差异无统计学意义（P>0.05）。A组血清IL-37、IFN-γ水平均较B组高（P<0.01）；治疗后与B组相比，IL-37差异无统计学意义（P>0.05），而IFN-γ的差异有统计学意义（P<0.01）。PASI评分与同期1，25（OH）₂D₃、IL-37和IFN-γ水平均存在相关关系。结论： NB-UVB联合卡泊三醇治疗PV疗效好，可有效改善患者皮损，减轻症状，降低血清IL-37、IFN-γ水平，提高血清1，25（OH）₂D₃水平。

Objective: To evaluate the efficacy of narrow-band ultraviolet B(NB-UVB) combined with calcipotriol in the treatment of psoriasis vulgaris(PV), to analyze the expression and significance of serum 1,25(OH)₂D₃ and IL-37 before and after treatment, and to explore the pathogenesis and treatment mechanism of PV. Methods: 35 patients with moderate to severe PV (group A) were treated with NB-UVB combined with calcipotriol for 12 weeks. The efficacy was evaluated by psoriasis area and severity index (PASI) and visual analogue scale (VAS). The levels of serum 1,25(OH)₂D₃, IL-37, IFN-γ were detected in group A and another 35 healthy volunteers(group B), and their correlations with PASI scores were analyzed. Results: After treatment, PASI scores, VAS, serum IL-37 and IFN-γ levels in group A were significantly decreased(P<0.01). The level of serum 1,25(OH)₂D₃in group A was lower than that in group B(P<0.01), and there was no difference between group A and group B after treatment(P>0.05). The levels of IL-37 and IFN-γ in group A were higher than those in group B(P<0.01). After treatment, there was no difference in IL-37 between group A and group B (P>0.05), but there was a difference in IFN-γ(P<0.01). Correlations existed among PASI scores and 1,25(OH)₂D₃, PASI scores and IL-37, as well as among PASI scores and IFN-γ in the same period. Conclusion: NB-UVB combined with calcipotriol has a positive effect on PV. It can reduce serum IL-37 and IFN-γ levels, and increase serum 1, 25(OH)₂D₃level.

参考文献：

[1] SEHAT M,TALAEI R,DADGOSTAR E,et al.Evaluating serum levels of IL-33,IL-36,IL-37 and gene expression of IL-37 in patients with psoriasis vulgaris[J].Iran J Allergy Asthma Immunol,2018,17(2):179-187.
[2] ALDHUBAIBI M S.Association between vitamin D deficiency and psoriasis:an exploratory study[J].Int J Health Sci,2018,12(1):33-39.
[3] 乔建忠,徐标,王昆,等.银屑病合并冠心病临床特点分析[J].现代医学,2016,44(4):488-492.
[4] DUA I,AGGARWAL K,JAIN V K,et al.Comparative evaluation of efficacy and safety of calcipotriol versus tacalcitol ointment,both in combination with NB-UVB phototherapy in the treatment of stable plaque psoriasis[J].Photodermatol Photo,2017,33(5):275-281.
[5] MEHTA D.Ultraviolet B phototherapy for psoriasis:review of practical guidelines[J].Am J Clin Dermatol,2016,17:125-133.
[6] TAKAHASHI H,TSUJI H,ISHIDA-YAMAMOTO A.Comparison of clinical effects of psoriasis treatment regimens among calcipotriol alone,narrowband ultraviolet B phototherapy alone,combination of calcipotriol and narrowband ultraviolet B phototherapy once a week,and combination of calcipotriol and narrowband ultraviolet B phototherapy more than twice a week[J].J Dermatol,2013,40:424-427.
[7] BOSWELL K,CAMERON H,WEST J,et al.Narrowband-UVB treatment for psoriasis is highly economical and causes significant savings in cost for topical treatments[J].Br J Dermatol,2018,179(5):1148-1156.
[8] ZHOU Q,QIN S,ZHANG J,et al.1,25(OH)2D3 induces regulatory T cell differentiation by influencing the VDR/PLC-γ1/TGF-β1/pathway[J].Mol Immunol,2017,91:156.
[9] ORGAZ-MOLINA J,BUENDÍA-EISMAN,ARRABAL-POLO M A,et al.Deficiency of serum concentration of 25-hydroxy vitamin D in psoriatic patients:a case-control study[J].J Am Acad Dermatol,2012,67(5):931-938.
[10] CHANDRASHEKAR L,KUMARIT G R,RAJAPPA M,et al.25hydroxy vitamin D and ischaemiamodified albumin levels in psoriasis and their association with disease severity[J].Br J Biomed Sci,2015,72:5660.
[11] ORGAZ MOLINAO J,MAGROCHECA C,ROSALESALEXANDER J L,et al.Vitamin D insufficiency is associated with higher carotid intima-media thickness in psoriatic patients[J].Eur J Dermatol,2014,24(1):53-62.
[12] GANZETTI G,CAMPANATI A,SCOCCO V,et al. The potential effect of the tumour necrosis factor-α inhibitors on vitamin D status in psoriatic patients[J].Acta Derm Venereol,2014,94:715-717.
[13] SOLAK B,DIKICIER B S,CELIK H D,et al.Bone mineral density,25OH vitamin D and inflammation in patients with psoriasis[J].Photodermatol Photoimmunol Photomed,2016,32:153-160.
[14] MALEKI M,NAHIDI Y,AZIZAHARI S,et al.Serum 25OH vitamin D level in psoriatic patients and comparison with control subjects[J].J Cutan Med Surg,2016,20:207-210.
[15] WANG X,XU K,CHEN S,et al.Role of interleukin-37 in inflammatory and autoimmune diseases[J].Iran J Immunol,2018,15(3):165-174.
[16] TENG X,HU Z,WEI X,et al.IL-37 ameliorates the inflammatory process in psoriasis by suppressing proinflflammatory cytokine production[J].J Immunol,2014,192(4):1815-1823.
[17] KURTOVIC N O,HALILOVIC E K.Serum concentrations of interferon gamma (IFN-γ) in patients with psoriasis:correlation with clinical type and severity of the disease[J].Med Arch,2018,72(6):410.
[18] SABAT R,WOLK K,LOYAL L,et al.T cell pathology in skin inflammation[J].Semin Immunopathol,2019,41:359-377.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录