窄谱中波紫外线治疗寻常型银屑病的优化方案探究

Optimizing therapeutics irradiation scheme on poriasis vulgaris through narrow-spectrum UVB

目的观察窄谱中波紫外线不同照射频率及递增剂量治疗寻常型银屑病的疗效,探究快速、安全的优化照射方案。方法选取解放军总医院2015年3月-2016年6月确诊为寻常型银屑病的128例患者,随机分为A组、B组和对照组(C组),3组均采用NB-UVB照射联合卤米松和卡泊三醇软膏外用治疗。A组每日照射1次,每次增量0.04 J/cm^2;B组每日照射1次,每次增量0.07 J/cm^2;对照组每周照射3次,每次增量0.1 J/cm^2。三组治疗前基线情况差异无统计学意义(P>0.05)。在治疗10 d、20 d时根据银屑病面积与严重性指数(psoriasis area and severity index,PASI)下降比例评估疗效,计算3组病情改善率并记录照射过程中不良反应。结果治疗10 d时,A组病情改善率(33.57%±7.30%)和B组病情改善率(47.81%±11.87%)均优于对照组(21.1%±9.6%)(P<0.05),且B组病情改善率优于A组(P<0.05);治疗20 d时,B组病情改善率(56.2%±19.8%)仍优于A组(43.3%±19.5%)和对照组(38.6%±12.4%)(P<0.05),A组病情改善率与对照组差异无统计学意义(P=0.475)。三组治疗期间无严重不良反应。结论在采用窄谱中波紫外线治疗寻常型银屑病时,选择每日照射1次,每次增量0.07 J/cm^2的治疗方案见效快,治疗时间短且无明显不良反应,可作为快速控制病情的首选治疗方案。

Objective To explore the optimal irradiation scheme of narrow band ultraviolet irradiation by analyzing the different frequency and dose increment in the treatment of psoriasis vulgaris.Methods A total of 128 patients with psoriasis vulgaris recruited from March 2015 to June 2016 in Chinese PLA General Hospital were randomly divided into group A（0.04 J/cm^2 dose increment,irradiation once a day）,group B（0.07 J/cm^2 dose increment,irradiation once a day） and control group（group C,0.1 J/cm^2 dose increment,irradiation 3 times a week）.All patients were treated by whole body NB-UVB radiation combined with kalbrometil ointment and halomethasone ointment.Age,disease course and severity index（PASI） score before treatment between the three groups showed no significant difference.The efficacy was evaluated according to the drop in proportion of psoriasis area and PASI at the 10 th day and 20 th day to calculate the improvement rate.The adverse reactions during irradiation were recorded.Results After 10 days treatment,the improvement rate of group B（47.81%±11.87%） was higher than that of group A（33.57%±7.30%） with statistically significant difference（P〈0.05）,and both group A and group B had advantage over the group C（P〈0.05）; After 20 days treatment,the improvement rate of group B（56.2%±19.8%） was still higher than that of group A（43.3%±19.5%） with significant difference（P〈0.05）,while no statistically significant difference in the improvement rate was found between group A and group C（P=0.475）.Conclusion The radiation protocol（0.07 J/cm^2 dose increment,once a day） is recommended as the first choice in the treatment of psoriasis vulgaris with narrow-band UVB due to its rapid onset,short duration and mild side effects.