窄谱中波紫外线照射对白癜风自体表皮移植的作用研究

Effects of narrow-band ultraviolet B radiation on the efficacy of autologous epidermal grafting for vitiligo

目的：探讨自体表皮移植联合窄谱中波紫外线（NB-UVB）照射治疗白癜风的临床疗效及可能作用机制。方法30例白癜风患者分为单纯表皮移植组和表皮移植联合NB-UVB组。用酶联免疫吸附测定检测局部皮损组织液中白细胞介素18（ IL-18）、肿瘤坏死因子α（ TNF-α）以及可溶性细胞间黏附分子1（sICAM-1）水平，并进行疗效评估。结果治疗前，单纯表皮移植组和表皮移植联合NB-UVB组局部皮损组织液中IL-18分别为（0.985±0.305）μg/L和（1.008±0.399）μg/L；TNF-α分别为（1.132±0.313）μg/L、（1.147±0.474）μg/L；sICAM-1分别为（1.215±0.284）μg/L、（1.221±0.432）μg/L；水平明显高于健康对照组（均P〈0.01）。表皮移植联合NB-UVB组治疗后各细胞因子水平基本恢复正常，有效率（68.9%）明显高于单纯表皮移植组（43.8%），P〈0.05。结论白癜风患者局部皮损处存在免疫异常，NB-UVB照射可以通过调节机体免疫功能提高表皮移植的成功率。

Objective To evaluate the clinical efficacy of autologous epidermal grafting combined with narrow-band ultraviolet B（NB-UVB）radiation for the treatment of vitiligo, and to explore their possible action mechanisms. Methods Totally, 30 patients with vitiligo were randomly and equally divided into 2 groups：epidermal grafting group treated with autologous epidermal grafting alone, and combination group treated with both autologous epidermal grafting and NB-UVB radiation. Fifteen healthy volunteers served as the healthy control group. Enzyme-linked immunosorbent assay（ELISA）was performed to detect the levels of interleukin-18（IL-18）, tumor necrosis factor-α（TNF-α）and soluble intercellular adhesion molecule-1 （sICAM-1） in interstitial fluid from the patients before and after the treatment, as well as from the healthy controls. Therapeutic effects were evaluated after 3-month treatment. Results Before the treatment, the epidermal grafting group and combination group both showed significantly increased levels of IL-18（0.985 ± 0.305μg/L, 1.008 ± 0.399μg/L, respectively）, TNF-α（1.132 ± 0.313μg/L, 1.147 ± 0.474μg/L, respectively）and sICAM-1（1.215 ± 0.284μg/L, 1.221 ± 0.432μg/L, respectively）in interstitial fluid compared with the healthy control group（all P〈0.01）. The levels of the three cytokines in the combination group almost all returned to normal after the 3-month treatment. In addition, the combination group showed a significantly higher response rate compared with the epidermal grafting group（68.9%vs. 43.8%, P〈0.05）. Conclusion Immune abnormalities exist in local lesions of patients with vitiligo, and NB-UVB radiation can increase the success rate of epidermal grafting likely by regulating the body′s immune function.