窄谱中波紫外线联合卡泊三醇治疗银屑病的效果及相应血清学指标的分析

Efficacy of calcipotriol combined with NB-UVB on psoriasis vulgaris and analysis of corresponding serological indexes

目的:评价窄谱中波紫外线(narrow-band ultraviolet B,NB-UVB)联合卡泊三醇治疗寻常型银屑病(psoriasis vulgaris,PV)的临床疗效,分析治疗前后血清1,25(OH)2D3、IL-37的表达变化及意义,探讨PV的发病和治疗机制。方法:对35例中重度PV患者(A组)采用NB-UVB联合卡泊三醇软膏治疗12周,以银屑病面积、严重程度指数(psoriasis area and severity index,PASI)和视觉模拟评分(VAS)评价疗效,检测其和35例健康志愿者(B组)血清1,25(OH)2D3、IL-37、IFN-γ的水平,并分析与PASI评分的相关性。结果:A组治疗后的PASI评分、VAS、IL-37水平和IFN-γ水平均显著降低(P <0.01)。A组血清1,25(OH)2D3水平较B组低(P <0.01);在治疗后与B组差异无统计学意义(P> 0.05)。A组血清IL-37、IFN-γ水平均较B组高(P <0.01);治疗后与B组相比,IL-37差异无统计学意义(P> 0.05),而IFN-γ的差异有统计学意义(P <0.01)。PASI评分与同期1,25(OH)2D3、IL-37和IFN-γ水平均存在相关关系。结论:NB-UVB联合卡泊三醇治疗PV疗效好,可有效改善患者皮损,减轻症状,降低血清IL-37、IFN-γ水平,提高血清1,25(OH)2D3水平。

Objective: To evaluate the efficacy of narrow-band ultraviolet B( NB-UVB) combined with calcipotriol in the treatment of psoriasis vulgaris( PV),to analyze the expression and significance of serum 1,25(OH)2D3 and IL-37 before and after treatment,and to explore the pathogenesis and treatment mechanism of PV. Methods: 35 patients with moderate to severe PV( group A) were treated with NB-UVB combined with calcipotriol for 12 weeks.The efficacy was evaluated by psoriasis area and severity index( PASI) and visual analogue scale( VAS). The levels of serum 1,25(OH)2D3,IL-37,IFN-γ were detected in group A and another 35 healthy volunteers( group B),and their correlations with PASI scores were analyzed. Results: After treatment,PASI scores,VAS,serum IL-37 and IFN-γ levels in group A were significantly decreased( P < 0. 01). The level of serum 1,25(OH)2D3 in group A was lower than that in group B( P < 0. 01),and there was no difference between group A and group B after treatment( P > 0. 05). The levels of IL-37 and IFN-γ in group A were higher than those in group B( P < 0. 01).After treatment,there was no difference in IL-37 between group A and group B( P > 0. 05),but there was a difference in IFN-γ( P < 0. 01). Correlations existed among PASI scores and 1,25(OH)2D3,PASI scores and IL-37,as well as among PASI scores and IFN-γ in the same period. Conclusion: NB-UVB combined with calcipotriol has a positive effect on PV. It can reduce serum IL-37 and IFN-γ levels,and increase serum 1,25(OH)2D3 level.