局部甲氧沙林加紫外线A治疗难治性蕈样肉芽肿皮损的初步研究

Efficacy and safety of topical PUVA treatment for refractory lesions of mycosis fungoides

目的探讨局部甲氧沙林加紫外线A（PUVA）治疗难治性蕈样肉芽肿（MF）皮损的有效性和安全性。方法回顾分析2008年至2014年就诊、治疗并长期随访的150例MF患者的资料，其中有10例符合入选标准及排除标准，其中男4例，女6例，年龄（46．0±9．4）岁，病程（12．4±7．7）年。其中斑块期7例，肿瘤期3例，皮损数量为（1．9±0．9）个。治疗区域外用补骨脂酊30min后行全身紫外线A（UVA）照射治疗，每周3次，评估治疗有效率以及不良反应发生率。结果10例MF患者局部PUVA的治疗次数为（18．10±14．61）次，总剂量为（161．60±135．96）J／cm^2。患者接受UVA照射的总剂量为（1953．25±829．73）J／cm^2，治疗次数为（261．90±116．79）次，治疗时间为（45．80±26．64）个月。全组患者完全缓解6例，部分缓解3例，无效1例，有效率为90．0％。全组患者未见明显严重的不良反应。结论局部PUVA治疗难治性MF皮损有效率高，并具有较好的安全性。

Objective To evaluate the efficacy and safety of topical PUVA treatment of refractory lesions of mycosis fungoides. Methods From January 2008 to 2014, a total of 10 patients（4 males and 6 females） with mycosis fungoides were treated with topical PUVA in Peking Union Medical College Hospital, including 7 cases in plaque stage and 3 cases in tumor stage. The average number of lesions were 1.9＋0.9. The median age of these patients was （ 46.0± 9.4 ） years. The average course of disease was （ 12.4± 7.7 ） years. Psoralen was applied topically on treatment area 30 min before total body UVA irradiation treatment, 3 times a week. And the efficiency and safety of the therapy were evaluated. Results All the patients were treated with topical PUVA with a median total dose of （161.60±135.96） J/cm^2 in an average of （18.10±14.61） fractions. Total dose of UVA was （ 1 953.25±829.73） J/cm^2, and total number of treatment was （261.90± 116.79 ） fractions. The total treatment time was （ 45.80± 26.64 ） months. Complete clinical response （ CR ） rate was 60.0%, partial response （PR） rate was 30.0%, and the overall response rate （CR＋PR） was 90.0%. One patient showed no response. No severe acute or chronic side effects were observed. Conclusion Topical PUVA therapy is effective in the treatment of refractory lesions of mycosis fungoides with little severe side effects.