平头火针联合308 nm准分子光治疗白癜风的疗效及对皮损组织ET-1和IL-17水平的影响

Efficacy of Flat-end Fire Needle Combined with 308 nm Excimer Laser in the Treatment of Vitiligo and Its Influence on Levels of Endothelin-1 and Interleukin-17 in Skin Lesions Tissues

目的:分析平头火针联合308 nm准分子光治疗白癜风的疗效及对皮损组织内皮素-1(ET-1)、白介素-17(IL-17)水平的影响。方法:选取笔者医院收治的126例白癜风患者作为研究对象,采用随机数字表简单随机分组法分为对照组及观察组,各63例。对照组给予308 nm准分子光治疗,观察组在对照组基础上联合平头火针治疗,疗程12周。记录两组靶皮损面积、外观恢复情况及临床疗效,比较两组治疗前及治疗4周后皮损组织ET-1、IL-17水平差异,并评估治疗前及治疗12周后外周血辅助性T细胞17(Th17)、调节性T淋巴细胞(Treg)、Th17/Treg变化情况,观察治疗期间不良反应。结果:两组患者均完成12周治疗,治疗12周后,两组靶皮损面积均较治疗前缩小(P<0.05),且观察组小于对照组(P<0.05),观察组复色面积占皮损总面积及临床疗效均高于对照组(P<0.05)。治疗4周后,两组皮损组织ET-1水平均较治疗前升高(P<0.05),且观察组高于对照组(P<0.05);IL-17水平则较治疗前降低(P<0.05),且观察组低于对照组(P<0.05)。两组治疗前后外周血Treg水平无显著变化(P>0.05);治疗12周后,两组外周血Th17及Th17/Treg均较治疗前降低(P<0.05),且观察组低于对照组(P<0.05)。两组不良反应发生情况比较(23.81%vs 20.63%),差异无统计学意义(P>0.05)。结论:平头火针联合308 nm准分子光治疗白癜风疗效显著,可调控皮损组织ET-1、IL-17表达,调节Th17/Treg平衡,不良反应较少。

Objective To analyze the efficacy of flat-end fire needle combined with excimer laser in the treatment of vitiligo and its influence on levels of endothelin-1(ET-1) and interleukin-17(IL-17) in skin lesion tissues. Methods A total of 126 patients with vitiligo in our hospital were selected as the research subjects, and they were divided into control group and observation group by the simple random grouping of the random number table method, with 63 cases in each group. Control group was given excimer laser treatment, and observation group was combined with flat-end fire needle on the basis of control group, and they were treated for 12 weeks. The target skin lesion area, appearance recovery and clinical efficacy were recorded in the two groups,and the differences in levels of ET-1 and IL-17 in skin tissues were compared between the two groups before treatment and after 4 weeks of treatment. Changes of peripheral blood helper T cell(Th17), regulatory T lymphocyte(Treg) and Th17/Treg were evaluated before treatment and after 12 weeks of treatment, and the adverse reactions were observed during treatment. Results Both groups of patients completed 12 weeks of treatment. After 12 weeks of treatment, the target skin lesion area in the two groups was smaller than that before treatment(P<0.05), and the area of observation group was smaller than that of control group(P<0.05).The proportion of recolor area and total skin lesion area and clinical efficacy in observation group were higher than those in control group(P<0.05). After 4 weeks of treatment, the ET-1 level of skin lesion tissues in the two groups were increased compared with those before treatment(P<0.05), and the level of observation group was higher than that of control group(P<0.05). IL-17 level was reduced compared with that before treatment(P<0.05), and the level of observation group was lower than that of control group(P<0.05). There was no significant change in peripheral blood Treg level between the two groups before and after treatment(P>0.05). After 12 weeks of treatment, the peripheral blood Th17 and Th17/Treg in the two groups were decreased compared with those before treatment(P<0.05), and the two indexes of observation group were lower than those of control group(P<0.05).There was no statistically significant difference in the occurrence of adverse reactions between the two groups(23.81% vs 20.63%)(P>0.05). Conclusion Flat-end fire needle combined with excimer laser has a significant efficacy on vitiligo. It can regulate the expressions of ET-1 and IL-17 in skin lesion tissues, and regulate the Th17/Treg balance, with fewer adverse reactions.