紫草乳膏外用联合窄谱中波紫外线对寻常型银屑病皮肤屏障及免疫功能的影响

Effect of comfrey cream combined with NB-UVB on skin barrier function and immune function in the patients with psoriasis vulgaris

目的探讨紫草乳膏外用联合窄谱中波紫外线(narrow band ultraviolet,NB-UVB)照射对寻常型银屑病患者皮肤屏障及免疫功能的影响。方法将符合入选标准的100例寻常型银屑病患者按随机数字表法分为2组,每组50例。对照组给予NB-UVB全身照射,观察组在对照组基础上于皮损部位涂擦紫草软膏。2组均治疗4周。分别于治疗前后进行皮损面积和严重程度指数(psoriasis area and severity index,PASI)评分,采用VAS量表评估皮肤瘙痒程度;采用DermaLab皮肤无创检测系统检测皮脂含量、角质层含水量、经表皮失水量(transepidennal water loss,TEWL),采用流式细胞仪检测患者外周血T淋巴细胞亚群(CD4^+、CD8^+、CD4^+/CD8^+)水平,评价临床疗效。结果观察组总有效率为98.0%(49/50)、对照组为84.0%(42/50),2组比较差异有统计学意义(χ^2=5.980,P=0.014)。观察组治疗后2、4周PASI评分与瘙痒评分均低于对照组(t值分别为3.462、2.833,P<0.01)。治疗后,观察组角质层含水量[(54.34±5.04)%比(49.03±5.26)%,t=5.154]、CD4^+[(42.06±4.68)%比(33.01±3.07)%,t=11.433]水平高于对照组(P<0.01),TEWL[(15.87±4.22)g/(h•m^2)比(19.87±3.06)g/(h•m^2),t=5.426]、皮脂含量[(143.03±11.60)μg/cm^2比(130.79±14.54)μg/cm^2,t=4.653]、CD8^+[(20.89±3.44)%比(26.03±3.44)%,t=7.471]水平、CD4^+/CD8^+[(1.89±0.29)比(1.43±0.27),t=8.209]比值均低于对照组(P<0.01)。结论紫草乳膏外用联合NB-UVB照射可有效改善寻常型银屑病患者的临床症状、提高皮肤屏障功能与免疫功能。

Objective To investigate the effects of comfrey cream combined with narrow-band UVB(NB-UVB)on skin barrier function and immune function in the patients with psoriasis vulgaris.Methods A total of 100 patients with psoriasis vulgaris admitted from March 2016 to June 2017 were enrolled in the study.They were randomly divided into observation group(Purple Cream+NB-UVB)and control group(NB-UVB),50 cases in each group.Psoriasis lesion area and severity index(PASI)and degree of pruritus were evaluated before treatment,after 2 weeks and 4 weeks of treatment.The skin barrier function and immune related indicators were compared between the two groups before and after the treatment.Results After treatment,the PASI score and pruritus score of the observation group and the control group showed a decreasing trend,and the observation group decreased more significantly.The interaction between the two groups at different time points,and between groups and at different time points were statistically significant(t values were 3.462,2.833,P<0.05).After treatment,the water content of the stratum corneum(54.34%±5.04%vs.49.03%±5.26%,t=5.154)and the sebum content(143.03±11.60μg/cm^2vs.130.79±14.54μg/cm^2,t=4.653)in the observation group were higher than those in the control group,and the transepidermal water loss(TEWL)[15.87±4.22 g/(h•m^2)vs.19.87±3.06 g/(h•m^2),t=5.426]in the observation group was lower than that in the control group(P<0.05).The CD4^+(42.06%±4.68%vs.33.01%±3.07%,t=11.433),CD4^+/CD8^+(20.89±3.44 vs.26.03±3.44,t=8.209)in observation group and control group were increased after treament,while CD8^+(1.89%±0.29%vs.1.43%±0.27%,t=7.471)was decreased,the observation group was superior to the control group(P<0.05).Conclusions Treatment of vulgaris vulgaris with comfrey cream combined with NB-UVB can improve symptoms and improve skin barrier function and immune function.