窄谱中波紫外线单一治疗重度银屑病

Narrow band ultraviolet monotherapy for severe psoriasis

目的评价窄谱中波紫外线（NB—UVB）单一治疗重度银屑病的临床疗效。方法按照治疗方案规律接受NB—UVB治疗的斑块型银屑病患者83例，根据病情严重程度分为轻中度组[银屑病面积及皮损严重指数（PASI）评分〈15，33例）和重度组（PASI评分≥15，50例）。治疗第2…468、12周对患者进行疾病严重程度评价（PASI评分），并记录不良事件及合并用药。研究结束后对治疗的有效性和安全性进行统计分析及评价，第8周作为主要疗效分析终点。结果治疗第8周轻中度组的PASI的下降比例为68．2（60．0％，78．6％），重度组为77．5％（51．0％，88．4％），均明显优于第4周。轻中度组PASI75、PASI90的比例为45．5％（15例）、21．2％（7例），而重度组PASI75、PASI90的比例为56．0％（28例）、28．0％（14例）。第2周时，轻中度组PASI下降比例22．8％（10．0％，46．3％）及PASI75的比例（12．1％）均明显高于重度组[13．4％（0．0％，27．1），0％]。不良反应主要为轻度红斑及水肿，轻中度组轻度红斑4例（12．1％），共11例次（1．9％）；重度组轻度红斑5例（10．0％），共16例次（1．4％），重度红斑l例（2．0％），共1例次（0．1％）。轻中度组轻度水肿1例（3．0％），共7例次（1．2％）；重度组3例（6．0％），共12例次（1．1％）。重度组发生治疗后轻度瘙痒1例（2．0％），共1例次（0．1％）。结论NB—UVB单一治疗对轻中度及重度寻常型银屑病均具有叮靠的疗效，重度银屑病患者对NB—UVB的治疗反应并不亚于轻中度患者。轻中度银屑病在治疗早期改善速度快于重度银屑病患者。

Objective To assess the efficacy and safety of narrow-band ultraviolet （NB-UVB） monotherapy for severe psoriasis. Methods Psoriasis patients were included in the study and assigned to mild-moderate group A [ psoriasis area and severity index （PASI） 〈 15 ] and severe group B （ PASI/〉 15 ）. Assessment of efficacy was made on week 2, 4, 6, 8, 12 with PASI score. Adverse events were recorded at each visit. Statistical comparison was made regarding efficacy and safety. The primary endpoint analysis was made on week 8. Results Eighty-three patients were included in two groups. PASI reduction at week 8 was 68. 2% （60.0% , 78.6% ） and 77.5% （51.0%, 88.4%） in group A and B. PASI in group A was 45.5%/21.2%, and it was 56.0%/28.0% in group B. The PASI reduction and PASI75 of group A [22.8% （ 10.0%, 46.3% ） and 12. 1% ] were both significandy higher than those of group B [ 13.4% （0.0%, 27.1% ）, 0% ]. Mild erythema and edema were the main adverse events. Conclusions NB-UVB monotherapy is effective for both mild-moderate and severe psoriasis. The overall response to treatment of severe psoriasis is no worse than that in mild-moderate patients. However the patients with mild-moderate psoriasis respond more quickly in the early stage of treatment.