窄谱中波紫外线照射联合他卡西醇软膏治疗面部稳定期白癜风疗效观察

Clinical Efficacy Observation of Narrow-band Ultraviolet B Irradiation Combined with Tacalcitol Ointment on Stable Vitiligo in Facial Region

目的:探究窄谱中波紫外线(NB-UVB)照射联合他卡西醇软膏对颜面部稳定期白癜风的治疗效果。方法:选取2018年3月-2020年11月到四川大学华西广安医院就诊的稳定期白癜风患者148例为研究对象,采用随机数字表法将其随机分为观察组和对照组各74例。对照组采用NB-UVB照射治疗,在对照组的基础上给予观察组他卡西醇软膏联合治疗。比较两组患者治疗6个月时的白癫风严重程度、皮损恢复状况(平均皮损面积、平均复色面积、面部不同部位平均复色时间);比较两组患者治疗前及治疗6个月时的外周血相关炎症因子[肿瘤坏死因子α(TNF-α)、干扰素γ(IFN-γ)、白细胞介素4(IL-4)]及T淋巴细胞亚群(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平、生活质量[白癜风专用生活质量量表(VitiQoL)];记录两组治疗期间不良反应发生情况。结果:治疗6个月时,观察组患者的白癜风严重程度较对照组明显改善(Z=2.101,P=0.036);治疗6个月时,观察组患者的平均皮损面积显著小于对照组,平均复色面积显著大于对照组,而其面部口鼻区、眼区、额区、颊区平均复色时间明显短于对照组(P<0.05);两组患者治疗6个月时的外周血TNF-α、IFN-γ水平明显降低,IL-4水平明显升高,CD4^(+)、CD4^(+)/CD8^(+)T细胞水平明显升高,CD8^(+)T细胞水平明显降低,且观察组与对照组间差异显著(P<0.05);治疗6个月时观察组的VitiQoL参与限制、耻辱感及行为评分显著低于对照组(P<0.05);两组治疗期间均未发生严重不良反应,其中观察组为20.55%,对照组为24.66%,组间比较无明显差异(P>0.05)。结论:给予稳定期白癜风患者NB-UVB照射联合他卡西醇软膏治疗,疗效确切且安全性良好。该疗法与常规NB-UVB照射相较可有效调节免疫反应,促进面部皮损复色,改善患者外貌美观的及生活质量。

Objective To explore the therapeutic effect of narrow-band ultraviolet B(NB-UVB)irradiation combined with tacalcitol ointment on stable vitiligo in facial region.Methods 148 patients with stable vitiligo who West China Guang'an Hospital of Sichuan University for treatment between March 2018 and November 2020 were selected as the research subjects,and they were divided into observation group and control group according to the random number table method,with 74 cases in each group.The control group was given NB-UVB irradiation,and the observation group was combined with tacalcitol ointment on the basis of the control group.The severity of vitiligo and recovery status of skin lesions(average skin lesion area,average repigmentation area,average repigmentation time of diff erent parts of the face)of the two groups of patients were compared at 6 months of treatment.The levels of peripheral blood-related infl ammatory factors[tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),interleukin-4(IL-4)]and T lymphocyte subsets(CD4^(+),CD8^(+),CD4^(+)/CD8^(+))and quality of life[Vitiligo-specifi c Quality of Life Scale(VitiQoL)]were compared between the two groups of patients before treatment and at 6 months of treatments.The occurrence of adverse reactions during treatment were recorded in the two groups.Results At 6 months of treatment,the severity of vitiligo in observation group was signifi cantly improved compared to control group(Z=2.101,P=0.036).At 6 months of treatment,the average skin lesion area of observation group was signifi cantly smaller than that of control group while the average repigmentation area was signifi cantly larger than that of control group,and the average repigmentation time of the mouth and nose area,eye area,frontal area and cheek area of face were signifi cantly shorter than those of control group(all P<0.05).The levels of peripheral blood TNF-αand IFN-γof the two groups of patients at 6 months of treatment were signifi cantly decreased while the level of IL-4 was signifi cantly increased,and the levels of CD4^(+)and CD4^(+)/CD8^(+)T cells were signifi cantly risen while the level of CD8^(+)T cells was signifi cantly reduced,and there were signifi cant diff erences between observation group and control group(all P<0.05).The scores of participation restriction,stigma and behavior of VitiQoL scale were signifi cantly lower in observation group than those in control group at 6 months of treatment(all P<0.05).No serious adverse reactions occurred during treatment in the two groups,and the incidence rate was 21.29%in observation group and was 24.66%in control group(P>0.05).Conclusion NB-UVB irradiation combined with tacalcitol ointment has a defi nite effi cacy and good safety in the treatment of patients with stable vitiligo.Compared with conventional NB-UVB irradiation,this therapy can eff ectively regulate the immune response,promote the repigmentation of facial skin lesions,and improve the appearance and quality of life.