308nm准分子光联合JAK抑制剂治疗中重度斑秃的疗效观察

Clinical Observation on 308 nm Excimer Light Combined with JAK Inhibitors in the Treatment of Moderate to Severe Alopecia Areata

目的:探讨308 nm准分子光联合Janus激酶(Janus kinases,JAKs)抑制剂枸橼酸托法替布治疗中重度斑秃的疗效和安全性。方法:选择2020年9月-2022年7月于荆门市人民医院皮肤科就诊的58例中重度斑秃(脱发面积≥25%)患者,随机分为对照组(n=26)和治疗组(n=32),两组均予以枸橼酸托法替布口服,治疗组予以308 nm准分子光联合治疗,疗程均为12周。观察两组临床疗效,对比治疗前后毛发镜检测结果和外周血IFN-γ、TNF-α及IL-10的水平,记录治疗期间不良反应发生情况,同时进行为期6个月的随访,比较复发率。结果:治疗组有效率90.63%高于对照组的65.38%(P<0.05)。治疗后,两组毛发密度、毛囊密度、毛发直径均较前升高,毳毛率较前下降(P<0.05),且治疗组的变化幅度均高于对照组(P<0.05)。治疗后,两组IFN-γ、TNF-α水平下降,IL-10水平上升(P<0.05),且治疗组IFN-γ、TNF-α水平低于对照组,IL-10水平高于对照组(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。治疗后6个月随访,治疗组复发率9.68%,对照组复发率34.78%(P<0.05)。结论:308 nm准分子光联合JAK抑制剂治疗中重度斑秃的疗效优于单独使用JAK抑制剂,且复发率更低,具有良好的疗效和较高的安全性。

Objective To evaluate the efficacy and safety of Janus kinase(JAK)inhibitors combined with 308-nm excimer lamp in the treatment of moderate to severe alopecia areata.Methods Fifty-eight cases of moderate to severe alopecia areata(at least 25%scalp hair loss)who attended the Department of Dermatology of Jingmen People's Hospital from September 2020 to July 2022 were selected and randomly divided into the control group(n=26)and treatment group(n=32).Both groups were treated with 5 mg tofacitinib twice daily for 12 weeks.The treatment group was treated with 308 nm excimer light twice a week additionally.The therapeutic effects on these two groups were observed.The trichoscopy results,levels of peripheral blood interferon-γ(IFN-γ),tumor necrosis factorα(TNF-α),and interleukin 10(IL-10)before and after treatment were compared.The occurrence of side effects during treatment was recorded.Subsequently,a 6-month follow-up was conducted in order to compare the recurrence rates.Results After the 12-weeks treatment,the total response rates of the treatment group and the control group were 90.63%and 65.38%.The comparison between the two groups were significantly different(P<0.05).After treatment,the hair density,hair follicle density,and hair diameters were improved,meanwhile,the vellus hair rate was reduced for both groups.The change is significant(P<0.05).The enhancement of the treatment group was higher than the control group(P<0.05).After treatment,IFN-γand TNF-αin the treatment group were lower than those in the control group,and IL-10 in the treatment group was higher than that in the control group(P<0.05).The incidences of the adverse reactions in the two groups during treatment were 6.25%and 3.85%respectively(P>0.05),and no severe adverse effects were observed.After the 6-months follow-up,the recurrence rates were 9.68%and 34.78%in the treatment and control groups(P<0.05).Conclusion The 308 nm excimer light combined with JAK inhibitors is superior to JAK inhibitors alone in the treatment of moderate to severe alopecia areata.The former has a lower recurrence as well as the milder adverse reactions.