接触致敏剂治疗重型斑秃疗效及作用机制

Effect and Mechanism of Topical Contacts Sensitizer Therapy on Severe Alopecia Areata

目的探讨外用接触致敏剂二苯基环丙烯酮治疗重型斑秃的疗效。方法对15例重型斑秃患者进行二苯基环丙烯酮治疗,详细记录其临床资料、治疗反应、副作用。ELISA检测正常对照组及治疗前、治疗后3个月患者血清细胞因子IFN-γ、IL-5水平。结果有效率为60%,疗效与年龄、发病年龄、病程、维持治疗浓度、脱发面积、甲改变等无明显相关性。与正常对照组相比,15例斑秃患者血清IFN-γ水平显著增高,IL-5水平显著降低(P<0.05)。经3个月治疗后,斑秃患者血清IFN-γ水平显著减低(P<0.05),与正常对照组相对持平(P=0.342)。血清IL-5水平显著增高,但仍低于正常对照组(P<0.05)。结论二苯基环丙烯酮作为一种接触致敏剂,可能是通过引发了迟发型变态反应,降低Th1型细胞因子表达,改变了局部免疫反应类型,而使毛囊周期进入生长期,达到治疗目的。

Objective To analyze the effect of topical contacts sensitizer Diphencyprone therapy on severe alopecia areata（AA）, and explore its mechanism. Methods Recorded the clinical data, treatment response, side effects of 15 AA patients under Diphencyprone treatment in details. ELISA was performed to detect IFN-γ, IL-5 levelsof the normal control group and AA group before and after three months treatment. Results The total effective rate of of this treatment was 60%, and no significant correlation was found between efficacy with age, age of onset, duration, therapeutic concentrations, area of hair loss and nail change. Compared to the control group, 15 cases of serum IFN-γ levels were significantly higher and IL-5 levels were significantly lower in AA patients （P〈0.05）. After three months of treatment, serum IFN-γ levels in AA patients significantly reduced （P〈0.05）, but relatively same with the control group （P= 0.342）. Serum IL- 5 levels were significantly higher, but still lower than normal controls （P〈0.05）. Conclusion As a sensitizing agent, Diphencyprone probably causes delayed hypersensitivity, reduces expression of Th1-type cytokines, changes the type of local immune response to treat AA.