综合疗法治疗白癜风50例疗效观察

Therapeutic Observation on Comprehensive Therapy in Treatment of 50 Cases of Vitiligo

目的:探究综合疗法治疗白癜风的临床疗效机制,并检测对血清肿瘤坏死因子-α(TNF-α)、γ-干扰素(IFN-γ)、白细胞介素-17(IL-17)水平的影响。方法:收集2015年3月至2018年3月于中国人民解放军第四六三医院皮肤科诊治的白癜风病例患者100例,采用随机数字表法分成对照组、观察组各50例。对照组采用常规西药联合紫外线光疗治疗,观察组在对照组治疗基础上联合应用中药方剂加减治疗,治疗2个月后进行临床疗效评估。观察两组治疗总有效率、白癜风面积及严重程度指数(VASI)总评分、不良反应发生率改善情况,并检测患者外周血清TNF-α、IFN-γ、IL-17的水平以评价疗效。结果:观察组总有效率86.0%,对照组68.0%,两组疗效比较,差异有统计学意义(P<0.05);治疗后两组白癜风面积及VASI评分均有明显改善(P<0.05),组间比较观察组降低明显(P<0.05);观察组治疗后不良反应发生率明显低于对照组,差异有统计学意义(P<0.05);两组治疗后血清TNF-α、IFN-γ、IL-17水平均显著降低,组内及组间比较差异均具有统计学意义(P<0.05)。结论:运用西药联合紫外线光疗、中药治疗白癜风可明显提高临床疗效,有效促进症状体征的改善,并降低不良反应发生率,并且可以通过血清中TNF-α、IFN-γ、IL-17水平的变化预测白癜风病情程度与治疗效果。

Objective:To explore the clinical therapeutic mechanism of comprehensive therapy in treating vitiligo,and to detect the effects on serum levels of tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ) and interleukin-17(IL-17). Methods:Total 100 cases of vitiligo were collected from March 2015 to March 2018 in dermatology department of 463 Hospital of People’s Liberation Army. They were divided into control group and observation group according to random number tablet,50 cases in each group. The control group was treated with routine western medicine combined with ultraviolet light therapy,while the observation group was treated with traditional Chinese medicine prescription addition and subtraction on the basis of the control group. The clinical efficacy was evaluated after two months of treatment. The effective rate of treatment,the total score of vitiligo area and severity index(VASI) and the improvement of adverse reactions were observed. The levels of TNF-α,IFN-γand IL-17 in peripheral serum of patients were detected to evaluate the therapeutic effect. Results:The total effective rate was 86.0% in the observation group and 68.0% in the control group. There was statistical signifi cance between the two groups(P< 0.05). After treatment,the area of vitiligo and VASI scores in both groups were significantly improved(P< 0.05),and the incidence of adverse reactions in the observation group was significantly lower than that in the control group(P< 0.05). After treatment,serum levels of TNF-α,IFN-γ and IL-17 were significantly decreased,and there was statistical significance between the two groups(P< 0.05).Conclusions:Western medicine combined with ultraviolet phototherapy and traditional Chinese medicine can significantly improve the clinical efficacy,effectively promote the improvement of symptoms and signs,and reduce the incidence of adverse reactions. In clinical work,the severity and therapeutic effect of vitiligo can be predicted by abnormal changes of serum levels of TNF-α,IFN-γ and IL-17.