NB-UVB联合复方白芷酊及卤米松乳膏对进展期白癜风患者AMMC细胞黑素合成量的影响

方兆珺 李俊杰 周韵聪

[摘要]目的：探究窄谱中波紫外线（NB-UVB）联合复方白芷酊及卤米松乳膏对进展期白癜风疗效及患者毛囊外根鞘无色素黑素细胞（AMMC）黑素合成情况的影响。方法：选取2016年12月-2019年3月在笔者医院皮肤科就诊的70例进展期白癜风患者，随机分成常规组（35例）和联合组（35例）。常规组给予卤米松乳膏+NB-UVB治疗，联合组在常规組的基础上加用复方白芷酊。两组患者均连续治疗24周。观察并比较两组疗效、不良反应发生情况及AMMC细胞黑素合成量。结果：治疗12周时，联合组与常规组总有效率比较差异无统计学意义（82.86% vs 68.57%，P>0.05）;治疗24周时，联合组总有效率高于常规组（97.14% vs 80.00%），差异有统计学意义（P<0.05）。两组均有少部分患者出现轻度红斑反应，均在治疗后自行缓解，无其他严重不良反应发生。联合组AMMC细胞黑素合成量为显著高于常规组，差异有统计学意义（P<0.05）。结论：卤米松乳膏+NB-UVB+复方白芷酊对进展期白癜风患者疗效显著，能够提高AMMC细胞黑素合成量，有效促进白斑消退，缓解其临床病症，值得临床推广与应用。

[关键词]进展期白癜风;窄谱中波紫外线;复方白芷酊;卤米松乳膏;毛囊外根鞘;无色素黑素细胞;黑素合成

Abstract： Objective  To investigate the effect of narrow-band ultraviolet B （NB-UVB） combined with compound angelica dahurica tincture and halometasone cream on on the efficacy of vitiligo and melanin synthesis of amelanotic melanocytes （AMMC） in the outer root sheath of hair follicles in patients with progressive vitiligo. Methods  70 patients with progressive vitiligo who visited the dermatological department of our hospital between December 2016 and March 2019 were randomly divided into the conventional group （35 cases） and the combined group （35 cases）. The conventional group was treated with halometasone cream +NB-UVB， while the combined group was treated with compound dahurian angelica tincture on the basis of the conventional group. All patients were treated continuously for 24 weeks. The curative effects， the occurrence of adverse reactions and in the two groups were observed and compared. Results  After 12 weeks of treatment， there was no significant difference in the total effective rate between the combined group and the conventional group （82.86% vs 68.57%， P>0.05）. At 24 weeks of treatment， the total effective rate in the combined group was higher than that in the conventional group （97.14% vs 80.00%， P<0.05）. A small number of patients in both groups developed mild erythema reaction， which were relieved after treatment without other serious adverse reactions. The amount of melanin synthesis in AMMC cells in the combined group was significantly higher than that in the conventional group， and the difference was statistically significant（P<0.05）. Conclusion  Halometasone cream +NB-UVB+ compound angelica dahurica tincture has a significant effect on patients with advanced vitiligo. It can improve melanin synthesis of AMMC cells， effectively promote leukoplakia regression. It is worthy of clinical promotion and application.

Key words： progressive vitiligo; narrow-band ultraviolet B （NB-UVB）; compound angelica dahurica tincture; halometasone cream; outer root sheath of hair follicle; amelanotic melanocyte（AMMC）; melanin synthesis

白癜风是一种先天性或获得性色素脱失性皮肤病，主要病理特征为黑素细胞渐进性、选择性破坏，亦有研究证实其属于器官特异性自身免疫性皮肤病，T细胞亚群水平，与其病情进展密切相关[1-3]。现阶段，白癜风治疗方法及药物种类众多，但尚无根治办法。如何选择药物以提高白癜风的治疗效果仍为当下研究热点之一。窄谱中波紫外线（Narrow-band Ultraviolet B，NB-UVB）及复方白芷酊、卤米松乳膏等药物治疗是当下常用治疗方法，但关于其联合应用对白癜风的疗效研究报道甚少[4-5]。基于此，本研究对笔者医院皮肤科就诊的70例进展期白癜风患者为研究对象进行对比性研究，旨在为提高白癜风临床治疗效果提供依据，现报道如下。