注射用人干扰素α-1b联合NB-UVB治疗蕈样肉芽肿1例

Human Interferon α-1b Injection Combined with NB-UVB in the Treatment of Mycosis Fungoides:A Case Report

患者男,63岁,腰腹部、大腿部红褐色斑1年余,无疼痛、瘙痒感。皮肤科检查:双侧腰腹部、大腿根部可见多处形态不规则片状暗红色斑,最大一处约9 cm×8 cm,边界清楚,伴轻度细小鳞屑,右侧皮损中心处轻度萎缩,表面无破溃及渗出。皮损组织病理:鳞状上皮组织,表面轻度角化,棘层略厚,真皮浅层较多淋巴细胞浸润,细胞异型性,并可见淋巴样单一核细胞移入表皮。免疫组织化学:CD3、CD2、CD4、CD5、CD7、CD8阳性。诊断:蕈样肉芽肿。采用注射用人干扰素α-1b 60μg,肌肉注射,隔日1次;窄谱中波紫外线,起始剂量为0.6 J/cm^(2),3次/周,每次增加原剂量的15%,外用氮芥、糖皮质激素,治疗随访2年后,皮损消退约76%,达到部分缓解。干扰素联合窄谱中波紫外线治疗早期蕈样肉芽肿有效。

A 63-year-old male presented with red-brown rash on the waist, abdomen and thigh for more than one year without pain and itching. Dermatology showed that there were a number of irregular flaky dark red spots on both sides of the waist, abdomen, and thigh roots. The largest spot was about 9 cm × 8 cm with clear borders and slight fine scales. The center of the skin lesion on the right side was slightly atrophy, and there was no damaged ulcer or exudation on the surface. Histological examination showed that the squamous epithelial tissue was accompanied by mild keratinization on the surface and the spinous layer was slightly thicker. There are more lymphocytes infiltrated in the superficial dermis, the cells are atypia, and lymphoid mononuclear cells can be seen to migrate into the epidermis. Immunohistochemistry showed CD3, CD2, CD4, CD5, CD7, and CD8 were positive. The patient was diagnosed as mycosis fungoides. He was given 60 μg of IFNα-1 b for injection once every other day. The initial dose of NB-UVB was 0.6 J/cm^(2), 3 times a week, with an increase of 15 % dose of the last time. After two years of treatment, the skin lesions subsided by about 80 % and reached partial remission. Interferon combined with NB-UVB is effective in the treatment of early MF.