308 nm准分子激光治疗白癜风

白癜风是一种常见的后天色素脱失性皮肤粘膜病，光疗对白癜风有明确的疗效。新近进入临床应用的308nm准分子激光，安全、高效、副作用小，在白癜风治疗中取得了令人瞩目的成就。本文就308nm准分子激光的作用原理及其在白癜风治疗中的应用综述如下。     

308nm准分子激光治疗眼眶白癜风的疗效观察

目的：评价308nm准分子激光治疗眼眶白癜风的疗效及安全性。方法：采用308nm准分子激光系统治疗83例眼眶稳定期白癜风患者,每周治疗2次,连续治疗10～30次,治疗1.5～3个月后进行疗效评价。结果：治疗10次、20次及30次后眼眶的显效率分别为54.17%、60.6%、88.46%。结论：308nm准分子激光治疗眼眶白癜风是安全有效的。     

阳明腑实证患者外周血Thl/Th2细胞因子的变化

观察阳明腑实证患者外周血Th1/Th2细胞因子变化情况，探讨其与肠源性内毒素血症的相关性。方法：25例患者随机分为两组，一组给予常规治疗作为对照组，另一组在常规治疗基础上给予复方大承气汤作为中药组，检测入院时及治疗后3d血浆内毒素（ET），血清干扰素У（IFN-У）、白细胞介素-4（IL-4）的变化，用IFN-У（IL-4）比值表示Thl／Th2的变化。结果：两组患者治疗后血浆ET、血清IFN-У、白细胞介素-4（IL-4）水平均降低，尤以中药治疗组降低更具有显著性（P〈0.05）。Thl/Th2比值升高。结论：复方大承气汤对阳明腑实证患者血清IFNУ、LI-4及Thl/Th2比值具有调节作用，阳明腑实证患者血清IFN-У、IL-4及Thl/Th2比值与肠源性内毒素血症有一定的相关性。     

自体表皮移植联合308nm准分子激光治疗白癜风疗效观察

白癜风是一常见的色素脱失性皮肤病,以表皮和毛囊黑素细胞破坏为特征,临床易诊断,但治疗时间长,见效慢。2005年8月～2006年2月,我们采用自体表皮移植联合308nm准分子激光治疗白癜风取得满意疗效,现报道如下。     

护理干预对他克莫司软膏联合308nm准分子激光治疗白癜风的影响

目的:探讨护理干预在他克莫司软膏联合308nm准分子激光照射治疗白癜风中的应用效果。方法:将120例白癜风患者按就诊顺序采用单双号抽签法分为治疗组60例和对照组60例;治疗组外涂他克莫司软膏联合308nm准分子激光照射同时配合适当的护理干预;对照组仅外涂他克莫司软膏联合308nm准分子激光照射,两组患者疗程均为6个月。采用统一的疗效评定标准进行疗效和安全性评价。结果:治疗组显效率为66.7%,对照组显效率为48.3%,差异具有统计学意义(χ2=4.36,P0.05);两组患者满意度比较,差异具有统计学意义(P0.05)。结论:他克莫司软膏外涂联合308nm准分子激光并配合适当的护理干预是治疗白癜风的有效方法,能显著提高疗效和患者满意度,值得推广应用。     

他克莫司软膏联合308nm准分子激光治疗儿童局限性白癜风

目的:本研究旨在评价0.03%他克莫司软膏和308 nm准分子激光治疗儿童局限性白癜风的安全性和有效性。同时研究308nm准分子激光联合外用0.03%他克莫司软膏对疗效的影响。方法:76个患者入组研究,研究采用随机单盲自身对照试验共15周。入组患者均具有两侧对称病变,进行左/右面部、躯干、手足的比较。按患者2至4个靶病变随机分为两组:A组患者外用0.03%他克莫司软膏,每天两次;B组患者外用0.03%他克莫司软膏每日两次,联合308nm准分子激光治疗,每周两次。研究期间对疗效和安全性因素进行评价。结果:76个患者完成了研究,A组91.3%和B组97.4%的皮损观察到复色。与治疗前相比,A组和B组皮损均明显改善。B组72.3%的皮损获得4级复色,与A组比较有显着性差异(P<0.05)。面颈部的复色率(复色75%以上)明显高于躯干、四肢、手足的复色率(P<0.05)。两组患者未见明显的副作用,两组之间的副作用发生率没有显著差异。结论:0.03%的他克莫司软膏和308 nm准分子激光对于治疗儿童局限性白癜风是安全、有效的,且耐受性良好。联合使用他克莫司软膏和308nm准分子激光显著提高疗效。     

他克莫司软膏联合308nm准分子激光治疗儿童局限性白癜风

目的:本研究旨在评价0.03%他克莫司软膏和308 nm准分子激光治疗儿童局限性白癜风的安全性和有效性。同时研究308nm准分子激光联合外用0.03%他克莫司软膏对疗效的影响。方法:76个患者入组研究,研究采用随机单盲自身对照试验共15周。入组患者均具有两侧对称病变,进行左/右面部、躯干、手足的比较。按患者2至4个靶病变随机分为两组:A组患者外用0.03%他克莫司软膏,每天两次;B组患者外用0.03%他克莫司软膏每日两次,联合308nm准分子激光治疗,每周两次。研究期间对疗效和安全性因素进行评价。结果:76个患者完成了研究,A组91.3%和B组97.4%的皮损观察到复色。与治疗前相比,A组和B组皮损均明显改善。B组72.3%的皮损获得4级复色,与A组比较有显着性差异(P<0.05)。面颈部的复色率(复色75%以上)明显高于躯干、四肢、手足的复色率(P<0.05)。两组患者未见明显的副作用,两组之间的副作用发生率没有显著差异。结论:0.03%的他克莫司软膏和308 nm准分子激光对于治疗儿童局限性白癜风是安全、有效的,且耐受性良好。联合使用他克莫司软膏和308nm准分子激光显著提高疗效。     

阳明腑实证患者外周血Th1/Th2细胞因子的变化

目的:观察阳明腑实证患者外周血Th1/Th2细胞因子变化情况,探讨其与肠源性内毒素血症的相关性.方法:25例患者随机分为两组,一组给予常规治疗作为对照组,另一组在常规治疗基础上给予复方大承气汤作为中药组,检测入院时及治疗后3d血浆内毒素(ET),血清干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)的变化,用IFN-γ/IL4比值表示Th1/Th2的变化.结果:两组患者治疗后血浆ET、血清IFN-γ白细胞介素-4(IL-4)水平均降低,尤以中药治疗组降低更具有显著性(P＜0.05).Th1/Th2比值升高.结论:复方大承气汤对阳明腑实证患者血清IFN-γ、IL-4及Th1/Th2比值具有调节作用,阳明腑实证患者血清IFN-γ、IL-4及Th1/Th2比值与肠源性内毒素血症有一定的相关性.     

他克莫司软膏联合308nm准分子激光治疗白癜风临床观察

目的:探讨外用0.1%他克莫司软膏联合308nm准分子激光治疗白癜风的疗效及安全性。方法:患者35例,以自身未治疗皮损作为空白对照,每例患者选择两处相近或对称部位的皮损,每周2次以308nm准分子激光进行治疗,共治疗16次。A组皮损同时每天早晚外用0.1%他克莫司软膏,B组单用308nm准分子激光治疗,试验结束时依据治疗前、后皮损的照片进行疗效评价。结果:试验结束时,未治疗的皮损均未出现任何改善,A组有效率为97.1%(34/35),B组为85.7%(30/35),显效率A组为74.3(&/35)、B组为48.6%(17/35),两组间显效率有显著性差(异2χ=4.884,P=0.023),但有效率差异不显著(2χ=2.917,P=0.088)。对18例患者进行随访,3个月内,A组所有治疗皮损均维持稳定或持续好转,而B组有3例皮损出现复发。结论:308nm准分子激光治疗白癜风疗效高、副作用少,联合外用0.1%他克莫司软膏可显著提高其疗效并减少复发。     

循证护理干预对308 nm准分子光治疗儿童白癜风疗效的影响分析

目的：探讨循证护理干预对308 nm准分子光治疗儿童白癜风疗效的影响。方法：选取笔者医院收治的50例白癜风患儿作为研究对象。根据治疗方式不同分为两组。其中对照组26例,研究组24例。两组均采用药物治疗联合308 nm准分子光疗,对照组采用常规护理,研究组采用循证护理干预,比较两组临床疗效、生活质量及不良反应情况。结果：治疗后,研究组的皮损色素评分显著高于对照组,皮损面积显著低于对照组,差异有统计学意义(P<0.05)。研究组不良反应发生率较对照组低,差异有统计学意义(P<0.05)。研究组的生活质量较对照组高,差异有统计学意义(P<0.05)。结论：药物及光疗治疗的基础上联合循证护理干预对白癜风患儿的疗效更为显著,同时还可降低其不良反应发生率,最终提高患儿的生活质量,值得临床推广应用。     

单用308nm准分子激光与联合他卡西醇治疗白癜风的疗效对比观察

目的 比较单用308nm准分子激光疗法治疗白癜风与联合局部应用维生素D3类似物他卡西醇治疗白癜风的疗效和安全性。方法 用单盲、自身对照的方法对78例稳定期泛发性的白癜风患者的自身对称或相邻的皮损采用308nm准分子激光治疗,实验组联合外用他卡西醇软膏,对照组用安慰剂软膏,1个月观察1次,拍照对比疗效,对78例患者进行治疗后评价。结果 不同治疗部位疗效评价：实验组头面、躯干、四肢皮损的总有效率分别为93．5l％,84．16％,42．35％,对照组总有效率分别为90．90％,77．45％,34．15％（P〈0．05）;不同类型的皮损治疗效果比较：实验组寻常型和节段型皮损总有效率分别为86．80％,93．33％,对照组分别为73．81％,84．00％（P〈0．05）;照光次数和累积照光剂量比较：实验组最初色素再生时照光次数和光累积量分别为（16．15±3．22）次和（4．40±5．03）J／cm＾2,对照组分别为（18．56±3．50）次和（6．60-i-1．01）J／cm。（P〈0．05）,显效的患者实验组为（20．36±1．50）次和（7．50±3．54）J／cm＾2,对照组为（21．68±2．40）次和（8．80±9．24）J／cm＾2（P〈0．05）。结论 308nm准分子激光治疗白癜风有效而且安全,联合他卡西醇外用可以提高白癜风患者的治疗反应,增强308nm准分子激光的疗效,缩短色素再生的时间,减少照光的能量。     

308nm准分子激光联合驱虫斑鸠菊肌注治疗白癜风临床观察

目的：观察308nm准分子激光联合驱虫斑鸠菊治疗白癜风的疗效及安全性。方法：将98例白癜风患者随机分为三组,其中对照组31例,治疗A组34例,治疗B组33例。对照组：应用驱虫斑鸠菊注射液2ml肌注,每日一次（早晨8点）;治疗A组：应用308nm准分子激光治疗,2～3次/周;治疗B组：采用308nm准分子激光联合驱虫斑鸠菊治疗。三组疗程均为2个月,由专人评价并记录治疗效果及治疗期间出现的不良反应。结果：①治疗B组总有效率为84.8%,明显高于其他两组（P＜0.01）;②治疗B组面颈部有效率为84.1%,躯干四肢为66.7%;均高于其他两组（P＜0.01）,且以面颈部有效率最高;③三组中肢端关节部位的有效率最低,且组间比较无显著性差异（P＞0.05）。结论：应用308nm准分子激光联合驱虫斑鸠菊治疗局限型的非肢端及非关节突出部位的白癜风,能获得满意疗效,可在临床推广应用。     

Rapid response of facial vitiligo to 308nm excimer laser and topical calcipotriene

Objective: Vitiligo is a common depigmenting condition that carries a high psychosocial morbidity. Many of the current topical and light therapies aid in repigmentation but require extensive treatment periods and carry unwanted side effects. The excimer laser is a newer treatment option that can induce repigmentation in an abbreviated time frame without global exposure to radiation. This case series provides further evidence to support the use of excimer laser in treating vitiligo especially of the face. Design: Patients with extensive facial depigmentation were treated with excimer laser twice weekly and calcipotriene daily until they developed significant repigmentation. Setting: Evaluation and treatment was performed at the Veterans Affairs outpatient dermatology clinic in Tampa, Florida. Participants: Three patients with Fitzpatrick skin types IV to VI were selected. These patients had failed a variety of topical treatments including steroids and calcipotriene, but were light naïve prior to beginning the study. Measurements: The primary outcome measure employed was percent repigmentation by visual estimation. The average dose of radiation, number of treatments, and weeks of therapy were also recorded. Results: All three patients experienced greater than 75 percent repigmentation of their facial vitiligo over a treatment course from 10 to 20 weeks. Conclusion: The excimer laser is a viable treatment for vitiligo and may yield results more expeditiously than other commonly utilized therapies. The rapid response may be correlated with skin type, but a more extensive study needs to be undertaken to further evaluate this correlation.Vitiligo is believed to be an autoimmune disease that results in the destruction of melanocytes leading to depigmentation. The disease affects approximately one percent of the population worldwide. Studies have demonstrated that the disfiguring nature of vitiligo causes high psychosocial morbidity.^1–3 This is especially pronounced in populations with darker skin tone, likely due to the marked contrast.^1,4A variety of treatment regimens are currently employed to repigment the skin. However, many of these require a prolonged treatment course and may yield minimal results. Therapies such as topical steroids rarely achieve more than 50- to 75-percent repigmentation and are cumbersome, requiring multiple daily applications. Further, topical steroids may require a year or more to note significant improvement.^5,6 Less than 50 percent of patients achieve greater than 75-percent repigmentation after 10 months of therapy.⁷ Other topical therapies including tacrolimus and calcipotriene yield similar results to topical steroids.Patients with extensive depigmentation may prefer treatment with light therapy due to the large surface area affected. Light therapies include oral or topical psoralens plus ultraviolet A radiation (PUVA), narrowband ultraviolet B radiation (NB-UVB), and excimer laser.PUVA has long been a mainstay of treatment for vitiligo, but over the last decade NB-UVB has been increasing in use due to decreased incidence of phototoxic side effects.^8,9 However, with both therapies, treatment may take many months, a year, or longer to achieve results.^8–10 PUVA achieved a partial response in 60 percent of patients after a mean of 84.2 treatments.¹¹ Patients treated with NB-UVB experienced a partial response at four weeks, but mean repigmentation was still less than 50 percent by 12 weeks.¹² There is some evidence that light treatments used in combination with topical agents improve outcomes.¹³The 308nm excimer laser is a newer treatment option that can yield impressive results in an abbreviated timeframe.¹⁰ Nicolaidou et al¹⁰ reviewed the use of excimer laser and demonstrated that 15 to 50 percent of patients achieved greater than 75-percent repigmentation. Notably, excimer laser treatment periods were 15 weeks or less in the overwhelming majority of the studies analyzed.¹⁰ Additionally, there has been some evidence that excimer laser treatment causes faster, more complete repigmentation in patients with higher Fitzpatrick skin types.^13,14This case series examines three male patients with Fitzpatrick skin types IV to VI and their results after undergoing combination treatment utilizing excimer laser with calcipotriene.     

Th1/Th2 cytokine levels: A potential diagnostic tool for patients with necrotizing fasciitis

IntroductionNecrotizing fasciitis (NF) has emerged as rare but rapidly progressive, life-threatening severe skin and soft tissue infection. We conducted a study to investigate whether Th1/Th2 cytokines could serve as biomarkers to distinguish NF from class III skin and soft tissue infections (SSTIs).MethodsA retrospective review was performed for 155 patients suffering from serious skin and soft tissue infections from October 2020 to February 2022. Th1/Th2 cytokines were obtained from peripheral blood and wound drainage fluid samples. Data on demographic characteristics, causative microbiological organisms, Th1/Th2 cytokines, c-reactive protein, procalcitonin and white blood cell (WBC) were extracted for analysis. Factors with statistical difference(p < 0.1) were included in the multivariate logistic regression model. The clinical differential diagnostic values of interleukin-2(IL-2), IL-6, IL-10, tumor necrosis factor-α (TNF-α) and interferon-r (IFN-r) were analyzed by receiver operating characteristic (ROC) curve.ResultsAmong the 155 patients, 66(43%) patients were diagnosed as NF. We found no significant difference for sex, age, location of infection, coexisting condition, predisposition, duration of symptoms before admission and micro-organisms, WBC, procalcitonin and c-reactive protein in NF and class III SSTIs group. NF had higher levels of IL-6 in serum (50.46 [24.89, 108.89] vs. 11.87 [5.20, 25.32] pg/ml; p＜0.01), IL-10 in serum (3.45 [2.03, 5.12] vs. 2.51 [1.79, 3.29] pg/ml; p＜0.01), IL-2 in wound drainage fluid (0.89 [0.49, 1.33] vs. 0.63 [0.14, 1.14] pg/ml; p = 0.02), IL-6 in wound drainage fluid (5000.84 [1392.30, 13287.19] vs. 1927.82 (336.65, 6759.27) pg/ml; p＜0.01), TNF-a in wound drainage fluid (5.20 [1.49, 22.97] vs. 0.96 [0.12, 3.21] pg/ml; p＜0.01) and IFN-r in wound drainage fluid (1.32 [0.47, 4.62] vs. 0.68 [0.10, 1.88] pg/ml; p = 0.02) as compared to the class III SSTIs. Multivariate logistic regression analyses showed that IL-6 in serum, IL-10 in serum and TNF-a in wound drainage fluid exhibited independently significant associations with diagnosis of NF(p＜0.05). In ROC curve analysis of IL-2, IL-6, IL-10, TNF-a and IFN-r for diagnosis of NF, the area under the curve (AUC) of IL-6 in serum could reach to 0.80 (p＜0.001). Using 27.62 pg/ml as the cut off value, the sensitivity was 74% and the specificity was 79% in IL-6 in serum.ConclusionsTh1/Th2 cytokines, IL-6 in serum in particular, are potential biomarkers for the diagnosis of NF in the early stage. However, larger patient populations with multiple centers and prospective studies are necessary to ensure the prognostic role of Th1/Th2 cytokines.     

支气管哮喘患儿Th1/Th2细胞免疫平衡变化研究

目的探讨支气管哮喘患儿Th1/Th2细胞免疫平衡变化及其机制。方法选择急性发作期支气管哮喘患儿30名作为发作组,选择30名缓解期支气管哮喘患儿作为缓解组,选择30名健康小儿作为对照组,采用流式细胞仪检测各组静脉血Th1、Th2表达情况,采用酶联免疫吸附法检测三组患儿血清IL-4、IL-10、IFN-γ水平,比较各组患者Th1/Th2及血清IL-4、IL-10、IFN-γ表达变化水平。结果发作组静脉血Th1/Th2低于对照组及缓解组,血清IL-4、IL-10水平高于对照组及缓解组,IFN-γ水平低于对照组及缓解组。缓解组静脉血Th1/Th2低于对照组,血清IL-4、IL-10水平高于对照组,血清IFN-γ水平低于对照组。结论支气管哮喘患儿存在Th1/Th2免疫失衡,其可能是小儿支气管哮喘的发病机制之一。     

Th细胞因子在结直肠癌组织中的表达

目的 检测结直肠癌组织中Th类细胞因子的表达,探讨其与癌细胞转移的关系.方法 采用逆转录-聚合酶链反应(RT-PCR)检测40例不同分期结直肠痛患者癌组织中Th1类细胞因子[白细胞介素(IL)-2、γ-干扰素(IFN)]和Th2类细胞因子(IL-10)的表达,分析其表达与临床分期的关系.结果 Th1类细胞因子(IL-2、γ-IFN)在癌组织的表达量(2.22±0.90、3.26±1.15)较周围正常组织(3.07±1.67,4.77±1.52)低,而Th2类细胞因子(IL-10)在癌组织表达量(6.06±2.04)较周围正常组织(4.88±1.87)高,差异均具有统计学意义(P<0.05).Duke's分期C-D期患者癌组织中Th2细胞类细胞因子(IL-10)的表达量(5.44±1.68)较A～B期患者癌组织中的表达量(4.08±1.73)高,而Th1类细胞因子(IL-2、γ-IFN)在Duke's分期C-D期患者的癌组织的表达量(2.70±1.30、2.73±0.95)较A～B期患者癌组织中的表达(3.75±1.46、4.39±1.99)低,差异均有统计学意义(P<0.01).结论 结直肠癌组织中,Th1细胞表达向Th2细胞方向漂移,肿瘤组织局部呈免疫抑制状态并可能与肿瘤侵袭转移相关.