窄谱中波紫外线治疗慢性光线性皮炎的方案及影响因素分析

Narrow-band ultraviolet B phototherapy regimens for the treatment of chronic actinic dermatitis and analysis of factors influencing treatment compliance

目的 探讨窄谱中波紫外线（NB-UVB）光疗法治疗慢性光线性皮炎（CAD）的方案及影响治疗实施的相关因素。方法 对2008年1月至2015年6月间在复旦大学附属华山医院皮肤科接受NB-UVB光疗的CAD患者的人口学资料、光生物学测试结果、治疗参数和临床反应进行回顾性分析。采用SAS9.3软件对完成与未完成NB-UVB光疗者的临床资料通过t检验或χ2检验进行比较。结果 共79例CAD患者接受NB-UVB光疗，均为Fitzpatrick Ⅳ型皮肤，其中61例（77%）完成治疗，18例（23%）因无法耐受而退出。完成治疗者中，NB-UVB起始照射剂量为（0.08 ± 0.01） J/cm2，终点照射剂量为（0.32 ± 0.08） J/cm2，累积照射量为（5.9 ± 2.5） J，治疗次数为（28 ± 8）次。52例（85%）在照射剂量达到0.30 J/cm2时皮损基本清除。19例患者在光疗结束后再次进行光试验，其中16例对UVA敏感的患者中6例UVA-MED恢复正常，6例明显改善；16例对UVB敏感的患者中11例UVB-MED恢复正常，3例明显改善。单因素分析显示，患者性别、年龄、病程、长波紫外线（UVA）敏感度、UVB敏感度以及光斑贴试验和斑贴试验结果在完成治疗和未完成治疗患者之间比较，差异均无统计学意义（P 〉 0.05）。结论 于春季开始、起始剂量为0.08 J/cm2、终点剂量为0.30 J/cm2、疗程28次左右是适合CAD患者的NB-UVB光脱敏方案，可有效降低患者对UVA和UVB的敏感性。不同性别、年龄、病程以及光敏感程度的CAD患者均可尝试用NB-UVB光疗法治疗。

Objective To investigate the optimal regimen of narrow-band ultraviolet B （NB-UVB） phototherapy in the treatment of chronic actinic dermatitis （CAD）, and to analyze factors influencing treatment compliance. Methods Demographic data, results of photobiological tests, treatment parameters and clinical responses were collected from CAD patients who received NB-UVB phototherapy in Huashan Hospital affiliated to Fudan University from January 2008 to June 2015, and were reviewed retrospectively. Statistical analysis was done by using two independent samples t-test and chi-square test with SAS9.3 software to compare the clinical data between patients who completed and did not complete the NB-UVB phototherapy. Results A total of 79 CAD patients with Fitzpatrick skin type Ⅳ received NB-UVB phototherapy. Of these patients, 61 （77%） completed the whole treatment, while 18 （23%） dropped out because of intolerance to the NB-UVB radiation. Among the 61 patients who completed the treatment, the average initial, final and cumulative radiation doses of NB-UVB were （0.08 ± 0.01） J/cm2, （0.32 ± 0.08） J/cm2 and （5.9 ± 2.5） J respectively, and patients received （28 ± 8） times of treatment in average. When the radiation dose went up to 0.30 J/cm2, most skin lesions were cleared in 52 （85%） patients. A total of 19 patients received phototesting again after the end of phototherapy. Among 16 patients sensitive to ultraviolet A （UVA） before the treatment, 6 had normal minimal erythema dose to UVA （UVA-MED）, and another 6 had improved UVA-MED after the treatment. Among 16 patients sensitive to UVB before the treatment, 11 got normal UVB-MED and another 3 had improved UVB-MED after the treatment. Univariate analysis showed no significant differences in gender, age, duration of the disease, sensitivity to UVA and UVB radiation, results of photopatch test and patch test between the patients who completed and did not complete the treatment （all P 〉 0.05）. Conclusions The appropriate NB-UVB phototherapy for CAD patients should start at an initial radiation dose of 0.08 J/cm2 in spring and end at a final radiation dose of 0.30 J/cm2 for about 28 sessions, which can effectively reduce the photosensitivity to both UVA and UVB in CAD patients. Additionally, NB-UVB phototherapy can be applied in CAD patients of different gender, age, disease duration and photosensitive condition.