阿维A联合窄谱中波紫外线治疗寻常性银屑病的疗效及其对患者外周血细胞因子IFN-γ、IL-4及IL-17的影响

Effect of acitretin combined with narrow-band ultraviolet B in the treatment of psoriasis vulgaris and the influence on IFN-γ, IL-4 and IL-17 cytokines in peripheral blood

目的探讨阿维A联合窄谱中波紫外线治疗寻常性银屑病的临床疗效及其对患者外周血细胞因子干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)及白细胞介素-17(IL-17)的影响,为临床治疗寻常性银屑病的机制研究提供依据。方法选取我院皮肤科2013年12月至2015年6月期间收治的130例寻常性银屑病患者作为研究对象,按随机数表法将患者分为对照组和观察组,每组各65例,其中对照组给予阿维A治疗,观察组在对照组治疗的基础上联合窄谱中波紫外线治疗,观察两组患者的治疗效果;同时选取同期健康受检者65例作为正常健康组,采用ELISA方法对三组受试者的外周血细胞因子IFN-γ、IL-4及IL-17进行检测,并进行比较分析。结果观察组患者治疗的总有效率为92.31%(60/65),明显高于对照组的76.92%(50/65),差异有统计学意义(P<0.05);寻常性银屑病患者外周血细胞因子IFN-γ、IL-4及IL-17明显高于正常健康组,差异均有统计学意义(P<0.05);治疗后观察组患者的外周血IFN-γ和IL-17水平分别为(40.64±15.92)pg/m L和(66.45±15.16)pg/m L,均明显低于治疗前的(101.21±15.47)pg/m L和(103.42±13.62)pg/m L,也低于对照组治疗后的(79.52±16.67)pg/m L和(80.72±17.41)pg/m L,差异均有统计学意义(P<0.05),而外周血IL-4水平则差异无统计学意义(P>0.05);观察组患者的不良反应发生率为27.69%(18/65),对照组为29.23%(19/65),差异无统计学意义(P>0.05)。结论阿维A联合窄谱中波紫外线治疗寻常性银屑病疗效显著,其可能的作用机制是通过降低外周血相关因子水平提高治疗效果。

Objective To study the effect of acitretin combined with narrow-band ultraviolet B(NB-UVB) in the treatment of psoriasis vulgaris and the influence on IFN-γ, IL-4 and IL-17 cytokines in peripheral blood, and provide the evidences for exploring the mechanism for the clinical treatment of psoriasis vulgaris. Methods A total of 130 patients with psoriasis vulgaris, who admitted to our hospital from December 2013 to June 2015, were selected as the research subjects and randomly divided into control group and observation group, with 65 cases in each group. The control group was given acitretin combined with narrow-band UVB treatment, and the control group only received acitretin treatment. At the same period, 65 cases of healthy subjects were chosen as controls(healthy group). Using the ELISA method, the cytokine IFN-γ, IL-4 and IL-17 in three groups were detected, observed and compared. Results The total effective rate of the observation group(92.31%, 60/65) was significantly higher than that of the control group(76.92%, 50/65), P<0.05. The cytokine IFN-γ, IL-4 and IL-17 in patients with psoriasis vulgaris were significantly higher than those of the normal healthy group(P<0.05). The peripheral blood IFN-γ and IL-17 levels of observation group after treatment [(40.64±15.92) pg/m L,(66.45±15.16) pg/m L] were significantly lower than those before treatment[(101.21±15.47) pg/m L,(103.42±13.62) pg/m L](P<0.05), which were also significantly lower than the peripheral blood IFN-γ and IL-17 levels of the control group after treatment [(79.52±16.67) pg/m L,(80.72±17.41) pg/m L], while the peripheral blood IL-4 levels did not show significant changes on the same conditions(P>0.05). There was no significant difference between the observation group(27.69%, 18/65) and control group(29.23%, 19/65) in the incidence of adverse reactions(P>0.05). Conclusion Acitretin combined with narrow-band ultraviolet B has the significant clinical application in the treatment of psoriasis vulgaris. It’s possible mechanism may be related to reducing the factor levels to improve the therapeutic effect.