光综合疗法治疗难治性白癜风初步研究

发布时间：2018-09-19 13:41

【摘要】：目的:1、评估NB-UVB联合硫辛酸治疗散发型白瘢风的临床疗效及安全性。2、评估NB-UVB、C02点阵激光联合外用皮质类固醇激素乳膏治疗肢端型白癜风的临床疗效及安全性。方法:1、招募散发型白癜风患者,采用随机、双盲研究方法,将患者分为A、B两组。A组:NB-UVB(3次/周)+硫辛酸片(300mg/日);B组:NB-UVB(3次/周)+安慰剂(1片/日);疗程6个月,试验结束后评价治疗疗效。2、招募肢端型白癜风患者,采用随机、自身对照研究方法,将研究对象的对称性皮损随机分成A、B两组。A组:NB-UVB联合点阵激光及外用卤米松/三氯生乳膏;B组:NB-UVB联合外用卤米松/三氯生乳膏。点阵激光每2周一次,NB-UVB每周3次,卤米松/三氯生乳膏每天两次,疗程12周,试验结束后评价治疗疗效。结果:1、NB-UVB联合硫辛酸治疗散发型白瘢风试验中。治疗3月A组与B组显效率分别为42.9%(3/7),12.5%(1/8);有效率分别为85.7%(6/7),75%(6/8)。显效率(P=0.282,P0.05)及有效率(P=1.0,P0.05)均无明显统计学差异。治疗6月A组与B组显效率分别为57.1%(4/7),50%(4/8);有效率分别为100%(7/7),75%(6/8)。显效率(P=1.0,P0.05)及有效率(P=0.467,P0.05)均无明显统计学差异。不同部位复色率不同,躯干部位复色率较高:A组52.8±38.4%,B组40.4±29.7%;肢端复色率较低:A组10.5± 13.7%,B组0.33±0.81%。治疗过程中均未见明显严重不良反应。2、NB-UVB、点阵激光联合外用皮质类固醇激素乳膏治疗肢端型白癜风试验中,A组与B组显效率分别为31.25%(5/16),12.5%(2/16);有效率分别为50%(8/16),31.25%(5/16)。显效率(P=0.394,P0.05)及有效率(P=0.473,P0.05)均无明显统计学差异。A组开始复色出现在治疗2.67± 1周,B组为3.2±1.79周,满意度评分A组5.29±2.70,B组4.0±2.18。治疗过程中均未出现严重不良反应。结论:1、NB-UVB单一治疗散发型白癜风安全有效,治疗6月显效率及有效率分别为50%及75%。相同疗程下联合硫辛酸治疗组显效率及有效率均高于单一对照组,但两者疗效、显效率及有效率比较均无明显统计学差异,考虑可能为病例数过少,需扩大样本量进一步研究,该研究亦发现不同部位NB-UVB治疗疗效不同,躯干复色率较高,肢端最低。2、NB-UVB、C02点阵激光及外用皮质类固醇激素乳膏治疗肢端型白癜风安全有效,点阵激光治疗组显效率及有效率优于对照组,开始复色时间短于对照组,患者满意度高于对照组,但两者疗效、显效率及有效率均无明显统计学差异,考虑可能为病例数过少,需进一步扩大样本量研究。对常规治疗无效的肢端型患者可尝试该治疗方案。
[Abstract]:Objective: 1. To evaluate the clinical efficacy and safety of NB-UVB combined with lipoic acid in the treatment of sporadic leukoplakia. Two groups. A group: NB-UVB (3 times a week) + lipoic acid tablets (300 mg a day); B group: NB-UVB (3 times a week) + placebo (1 tablet a day); 6 months of treatment, after the end of the trial to evaluate the efficacy of treatment. 2, recruited patients with acral vitiligo, using a randomized, self-controlled study method, the symmetrical lesions of the subjects were randomly divided into A, B groups. A group: NB-UVB combined with lattice laser. Group B: NB-UVB combined with halometasone/triclosan cream. Dot-matrix laser once every two weeks, NB-UVB three times a week, halometasone/triclosan cream twice a day for 12 weeks. The therapeutic effect was evaluated after the trial. Results: 1. NB-UVB combined with lipoic acid in the treatment of sporadic leucorrhea. The efficiencies were 42.9% (3/7), 12.5% (1/8), 85.7% (6/7) and 75% (6/8), respectively. There was no significant difference between the efficiencies (P = 0.282, P 0.05) and (P = 1.0, P 0.05). The efficiencies of group A and group B were 57.1% (4/7), 50% (4/8), 100% (7), 75% (6/8) and 75% (P = 1.0, P = 0.467, P = 0.05). There was no significant difference between the two groups in the color change rate of different parts. The color change rate of trunk was higher in group A (52.8 65507 In the vitiligo test, the effective rates of group A and group B were 31.25% (5/16) and 12.5% (2/16), 50% (8/16) and 31.25% (5/16), respectively. There was no significant difference between the effective rates (P = 0.394, P 0.05) and the effective rates (P = 0.473, P 0.05). Conclusion: 1. NB-UVB alone is safe and effective in the treatment of sporadic vitiligo, and the effective rate is 50% and 75% in 6 months, respectively. The study also found that NB-UVB in different parts of the body had different therapeutic effects, with a higher rate of trunk discoloration and the lowest limb discoloration. NB-UVB, C02 lattice laser and topical corticosteroid cream were safe and effective in the treatment of acral vitiligo. The effective rate is better than that of the control group, the beginning of discoloration is shorter than that of the control group, and the patients'satisfaction is higher than that of the control group.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R758.41

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