窄谱中波紫外线对寻常型银屑病患者外周血IL－23／IL－17轴表达的影响

Effects of narrow-band ultraviolet B on expression of IL-23/IL-17 axis and efficacy in patients with psoriasis vulgaris

目的观察窄谱中波紫外线（NB-UVB）治疗寻常型银屑病的临床疗效及其外周血白介素-17（IL-17）、白介素-23（IL-23）、白介素-22（IL-22）等细胞因子表达的变化，探讨NB-UVB治疗寻常型银屑病的作用机制。 方法选取90例寻常型银屑病患者（进行期患者45例，稳定期患者45例），使用NB-UVB照射治疗8周，采用双抗体夹心ELISA法检测光疗前后血清IL-17、IL-23、IL-22、白介素-10（IL-10）、转化生长因子β（TGF-β）的含量，并对其临床疗效进行评价。同时选50例健康体检者作为健康对照组。 结果寻常型银屑病患者血清IL-17、IL-23、IL-22水平均显著高于健康对照组（P〈0.01），而IL-10和TGF-β水平显著低于健康对照组（P〈0.01）；NB-UVB治疗后IL-17、IL-23、IL-22水平明显降低，与治疗前相比，差异有统计学意义（P〈0.01），而IL-10和TGF-β水平明显升高，与治疗前相比，差异亦有统计学意义（P〈0.01）。90例患者治疗前PASI评分为（19.57±8.36）分，经NB-UVB治疗8周后，PASI评分较治疗前明显下降（P〈0.01），其中治疗后进行期患者PASI评分为（3.57±3.02）分，稳定期患者为（3.71±3.26）分。90例患者治疗后的总显效率为87.78%，其中进行期患者显效率为91.11%，稳定期患者的显效率为84.44%。 结论NB-UVB照射可明显下调外周血IL-17、IL-23和IL-22的水平，上调IL-10、TGF-β的水平，从而调节T细胞亚群的失衡，可能是NB-UVB治疗银屑病的机制之一。NB-UVB治疗各期寻常型银屑病疗效好，安全性高。

Objective To observe clinical efficacy of NB-UVB in treating psoriasis vulgaris and its effects on expression of serum interleukin-17 （ IL-17 ） , interleukin-23 （ IL-23 ） and interleukin-22 （ IL-22 ） in patients with psoriasis vulgaris, and to study the underlying mechanisms of NB-UVB. Methods Ninety patients were recruited and treated with NB-UVB therapy for 8 weeks. Before and after treatment, the serum level of IL-17, IL-23, IL-22, inter- leukin-10（IL-10） and transforming growth factor（ TGF-13） were tested by use of ELISA method, meanwhile Psoriasis Area and Severity Index （PASI） were used to evaluate clinical efficacy. Fifty healthy volunteers were selected as control group. Results Compared to healthy controls, the level of serum IL-17, IL-23 and IL-22 was significantly higher in patients with psoriasis vulgris （P 〈 0.01 ） , and IL-10, TGF-13 shown lower expression in psoriasis patients （P 〈0.01 ）. After 8 weeks of treatment with NB-UVB, serum levels of IL-17, IL-23 and IL-22 in psoriasis patients decreased significantly （P 〈 0.01 ） , while IL-10, TGF-13elevated significantly （P 〈 0.01 ） in contrast. The Psoriasis Area and Severity Index （PASI） results indicated significantly clinical improvement after therapy, and the total effective rate was 87.78%. Conclusion NB-UVB could down-regulate serum IL-17, IL-23, IL-22 and up-regulate IL-10, TGF-β, which may help regulate imbalance of T lymphocytes cells of psoriasis patients. The clinical data demonstrate that the treatment of NB-UVB is a safe, effective method for psoriasis vulgaris.