他卡西醇联合单频准分子光治疗白癜风的对照研究

Topical tacalcitol and MEL308 nm:a synergistic combination for the treatment of vitiligo

目的评价和对比他卡西醇联合单频准分子光(MEL)308 nm和单用单频准分子光治疗白癜风的疗效和安全性。方法用单盲、自身对照的方法对38例白癜风患者的自身对称或相邻的皮损分别外用他卡西醇和安慰剂,两侧皮损每周照射1次MEL 308 nm,1月观察1次,拍照对比疗效。计算最初色素再生和显效时的照光次数和光的累积量。结果对35例患者进行评价,联合治疗侧最初色素再生时的照光次数和光的累积量分别为(4．89±3．16)次和(4．27±3．59)J/cm^2,单照光侧分别为(5．69±3．29)次和(5．36±4．12)J/cm^2(P＜0．05),显效的患者联合治疗侧为(7．79±4．70)次和(7．72±5．64)J/cm^2,单照光侧为(8．4±3．92)次和(8．18±4．87)J/cm^2(P＞0．05)。联合治疗侧的显效率为45．7％,总有效率71．4％,单照光侧分别为25．7％和54．3％(P＜0．05)。结论单频准分子光治疗白癜风有效而且安全,联合他卡西醇外用可增强MEL 308 nm的疗效,提早色素再生的时间和减少照光的能量。

Objective To study the efficacy and safety of tacalcitol combined with monochromatic excimer light （ MEL ） 308 nm vs MEL 308 nm monotherapy in treating vitiligo. Methods Thirty-eight patients with vitiligo were enrolled in the single-blind clinical trial, using plabebo-treated lesions in the same patient as controls. Contralateral or nearby lesions were randomly selected to be treated by either tacalcitol or placebo. All lesions were treated weekly with MEL 308 nm, for a total of 12 sessions. Patients were examined at monthly intervals. The mean number of sessions and the cumulative dosage for initial and excellent repigmentation were calculated. Results Thirty-five patients were evaluated. The mean ± SEM cumulative dose and number of MEL exposures for initial repigmentation, respectively, were 4.27 ± 3.59 J/cm^2 and 4.89 ± 3.16 on tacalcitol-treated site, 5.36± 4.12 J/cm^2 and 5.69 ± 3.29 on placebo-treated site, respectively （ both P 〈 0.05 ）. For excellent repigmentation, the cumulative dose and number of exposures were 7.72 _± 5.64 J/cm^2 and 7.79 ± 4.70 respectively on tacalcitol-treated site, and 8.18 ± 4.87 J/cm^2 and 8.4 ±3.92 respectively on placebo-treated site （ both P 〉 0.05 ）. Treatment with tacalcitol resulted in a significantly higher percentage （ 71.4% vs 54.3% ） of repigmentation than that with placebo. Conclusions Our results show that MEL 308 nm is safe and effective for the treatment of vitiligo. Additionally, concurrent topical tacalcitol potentiates the efficacy of MEL 308 nm in the treatment of vitiligo; this combination achieves more rapid pigmentation with a lower total MEL dosage.