局部免疫法治疗重型斑秃的疗效及作用机制分析  

Topical Immunotherapy of Severe Alopecia Areata: Therapeutic Effects and Mode of Action

作　　者：巩毓刚[1] 赵莹[1] 张小婷[1] 叶艳婷[1] 杨建[1] 章星琪[1] 

机构地区：[1]中山大学附属第一医院皮肤性病科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2012年第2期216-222,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：中山大学引进人才科研启动经费(18901208)

摘　　要：【目的】分析局部免疫法治疗中国重型斑秃患者的疗效及探讨其作用机制。【方法】对63例斑秃患者进行二苯环丙烯酮局部免疫治疗。治疗前进行皮肤镜、实验室、病理检查,治疗过程中对血常规、总IgE进行监测并复查部分患者头皮病理。同时检测21名患者治疗前后血清细胞因子浓度,并征集正常对照13人,年龄性别与斑秃组相匹配。【结果】本组患者总有效率为61.0%,疗效仅与脱发面积成负相关,即面积越小,疗效越好,而与其它临床资料无相关关系。相比有效组,严重不良反应组治疗前血清IgE浓度较高。经治疗后真皮浅层血管周围单个核细胞浸润明显增多。患者血清Th1型细胞因子IFN-γ、IL-12在治疗前较正常对照高,经治疗后有效组明显降低,与正常对照无差异,而无效组IFN-γ未降低,IL-12水平反而较治疗前升高。Th2型细胞因子IL-4在无效组治疗前后均高于正常组,IL-10均低于正常组,而在有效组该两种因子治疗前与正常无差异,治疗后升高,且高于正常水平。【结论】局部免疫法可用于治疗重型斑秃,疗效较确切,且相对较安全。治疗前进行IgE测定可初步预示治疗过程中炎症反应过强者,而IL-4升高可能提示对局部免疫疗法无效。治疗后有效组Th1型细胞因子的表达减少,恢复了原有Th1与Th2细胞因子的平衡状态,使毛囊从休止期重新进入生长期,达到毛发生长的治疗效果。【Objective】 To investigate the therapeutic effect of topical immunotherapy in Chinese severe alopecia areata（AA） patients and to explore the mechanism.【Methods】 Detailed clinical data in 63 patients of severe AA enrolled in this study were recorded.Laboratory blood tests,serum IgE level,scalp tissue biopsies were carried out pre-and post-treatment.In the course of treatment,global photographic views and dermoscopic features were analyzed to monitor the process of hair growth.Cytokine levels were measured in 13 healthy controls and 21 patients pre-and post-treatment.【Results】 The respond rate to treatment was 61.0%.Effectiveness of treatment did not correlate with any of clinical features,except that it correlated negatively with hair loss area.Pre-treatment serum IgE level was significantly higher in adverse-effects group than in responders group.Compared with pre-treatment,perivascular mononuclear cell infiltration in superficial dermis was significantly increased after treatment.It was also noted that,prior to treatment,alopecic patients had a remarkably higher serum level of Th1 cytokine such as IFN-γ and IL-12 when compared to healthy controls.Post-treatment levels of IFN-γ and IL-12 were significantly decreased,but levels of IL-4 and IL-10 were increased in the responder group,different from that in the non-responder group.In the non-responder group after treatment,IFN-γ level was not significantly decreased and an increase of IL-12 level was even found as compared to pre-treatment levels.Also,serum level of IL-4 was higher and IL-10 was lower than normal controls both pre-and post-treatment.【Conclusion】 Topical immunotherapy treatment is an effective way to treat severe AA patients and it is relatively safe.Pre-treatment serum IgE level can be used as a prognostic marker of treatment intolerance.Also,high level of IL-4 at pre-treatment may be a valuable indicator for non-responder.Mechanism of action can be interpreted as restoration of the immunological balance by decreasing Th1 cyto

关 键 词：斑秃 局部免疫疗法 细胞因子 Th1与Th2 

分 类 号：R758.4[医药卫生—皮肤病学与性病学]