沙利度胺联合糠酸莫米松乳膏封包及紫外线照射治疗结节性痒疹的疗效观察

Clinical efficacy of thalidomide, mometasone furoate cream under occlusion and ultraviolet irradiation for the treatment of prurigo nodularis

目的观察沙利度胺联合糠酸莫米松乳膏封包和紫外线照射治疗结节性痒疹的疗效。方法采用非随机同期对照研究方法，结节性痒疹患者80例，分别入选对照组（23例）、UVA1组（32例）、UVB组（25例），3组患者均口服沙利度胺75mg／d每晚1次，0．1％糠酸莫米松乳膏每晚1次均匀涂抹于整个患侧肢体或躯干部位并用保鲜膜封包；UVA1组和UVB组同时分别给予UVA1和窄谱UVB照射。在治疗前、治疗后30天分别对患者病情严重程度评分。应用秩和检验比较组间皮损临床疗效与瘙痒疗效，同时对外周血嗜酸粒细胞绝对计数与瘙痒视觉评分进行关联性分析。结果①治疗30d后，皮损改善的临床疗效：对照组、UVA1组、UVB组显效分别为5例（21．74％）、13例（43．33％）、9例（37．5％），有效分别为7例（30．43％）、12例（40％）、7例（29．17％），对照组疗效显著低于UVA1组（Z=8．21，P〈0．01）和UVB组（Z=5．22，P〈0．01），UVA1组和UVB组疗效接近（Z=0．50，P〉0．05）；②瘙痒改善的临床疗效：治疗30d后，对照组、UVA1组、UVB组显效分别为7例（30．43％）、18例（60．00％）、14例（58．33％），对照组疗效低于UVA1组（Z=4．50，P〈0．01）和UVB组（Z=4．50，P〈0．01），UVA1组与UVB组疗效接近（Z=0．35，P〉0．05）；③对患者的嗜酸粒细胞计数与瘙痒评分进行相关分析，r=0．53，P〈0．01。结论沙利度胺联合糠酸莫米松乳膏封包，及联合紫外线照射治疗结节性痒疹均有显著疗效，且联合UVA1、UVB的疗效优于沙利度胺联合糠酸莫米松乳膏封包。

Objective To evaluate the clinical efficacy of thalidomide plus mometasone furoate cream under occlusion and ultraviolet irradiation for the treatment of prurigo nodularis. Methods A non-randomized, parallel, controlled study was carried out. Eighty patients with prurigo nodularis were divided into 3 groups, i.e., control group （no irradiation）, ultraviolet A1 （UVA1） group, and uhraviolet B （UVB） group. All the patients were treated with oral thalidomide and topical mometasone furoate cream under occlu＇sion. Additionally, the patients in UVA1 group and UVB group received UVA1 and NB-UVB irradiation, respectively, thrice a week for no less than 8 weeks. Patients were evaluated at the baseline, and on day 30 after the beginning of treatment. Clinical outcome parameters included disease severity score and visual analogue scales for pruritus. Peripheral blood eosinophils were counted during each visit. Rank sum test was performed to compare the clinical efficacy between the 3 groups, and the relationship between peripheral blood eosinophile count and visual analogue scales for pruritus was analyzed. Results After 30 days of treatment, skin lesions were markedly improved in 5 （21.74%）, 13 （43.33%） and 9 （37.5%） patients, and improved in 7 （30.43%）, 12 （40%） and 7 （29.17%） patients, in the control group, UVA1 group and UVB group respectively; a marked response in pruritus was noted in 7（30.43%）, 18（60.00%） and 14 （58.33%） patients respectively in the control group, UVA1 group and UVB group. The efficacy on skin lesions and pruritus was significantly stronger in the UVA1 group and UVB group than in the control group （skin lesions： Z = 8.21, 5.22, both P 〈 0.01; pruritus： Z = 4.50, 4.50, both P 〈 0.01）, but similar between the UVA1 group and UVB group （skin lesions： Z = 0.50, P 〉 0.05; pruritus： Z = 0.35, P 〉 0.05）. Peripheral blood eosinophil count was positively correlated with the visual analogue scale for pruritus in the patients （r = 0.53, P 〈 0.01 ）. Conclusions Thalidomide combined with mometasone furoate cream under occlusion and ultraviolet irradiation shows notable efficacy for the treatment of prurigo nodularis, and the combination with UVA1 or NB-UVB irradiation enhances the efficacy of thalidomide and mometasone furoate cream under occlusion.