甲氧沙林加紫外线A联合窄谱中波紫外线B治疗早期蕈样肉芽肿的疗效观察  

Combined therapy of psoralen plus ultraviolet A followed by narrow band ultraviolet B photochemotherapy for early stage mycosis fungoides

作　　者：王涛[1,2,3] 刘跃华[1,2,3] 郑和义[1,2,3] 左亚刚[1,2,3] 方凯[1,2,3] 

机构地区：[1]中国医学科学院,100730 [2]北京协和医学院 [3]北京协和医院皮肤科

出　　处：《中华肿瘤杂志》2014年第8期626-628,共3页Chinese Journal of Oncology

摘　　要：目的分析甲氧沙林加紫外线A（PUVA）联合窄谱中波紫外线B（NB-UVB）治疗早期蕈样肉芽肿（MF）的疗效。方法24例经病理检查证实的早期MF患者，分别行PUVA治疗（9例）、NB-UVB治疗（6例）以及PUVA治疗好转后行NB-UVB的联合治疗（9例），分析患者的性别、发病年龄、TNM分期、治疗方法、治疗时间、治疗次数、维持治疗时间、预后及复发情况。结果24例MF患者的平均治疗次数为104．5次（95％CI为75．71～133．29次），平均治疗时间为12．88个月（95％CI为9．90～15．85个月），平均维持治疗时间为11．08个月（95％CI为2．13～20．04）。PUVA组患者的治疗有效率为88．9％，复发率为11．1％。NB-UVB组患者的治疗有效率为100．0％，复发率为33．3％。PUVA和NB-UVB联合组患者的治疗有效率为77．8％，复发率为55．6％。PUVA组、NB-UVB组、PUVA和NB-UYB联合组患者的治疗次数、治疗时间、维持治疗时间、治疗有效率和复发率差异均无统计学意义（均P〉0．05）。结论PUVA和NB-UVB是治疗早期MF有效的皮肤靶向治疗方法。PUVA和NB-UVB联合治疗的方法可减少PUVA的总摄入量，减少了潜在的致癌风险。Objective Only a few clinical reports in the treatment of early mycosis fungoides （MF） （ I A, I B, Ⅱ A stage） are available in the literature. The purpose of this study was to compare the efficacy and safety of narrow-band UVB and psoralen plus ultraviolet A （PUVA） photochemoterapy in 24 patients with early-stage MF, and explore a new approach for the treatment of early mycosis fungoides. Methods A total of 24 identified early mycosis fungoides patients received PUVA, NB-UVB and a combined therapy of PUVA followed by NB-UVB （ n = 9/6/9） irradiation. A retrospective study was carried out to analyze the sex, age of onset, TNM stage, treatment, and duration of treatment, and times of treatment, duration of maintenance treatment, effective and recurrence in these patients. The data were analyzed using SPSS 17.0 and a two-sided test at the α= 0.05 level of significance was conducted. Results Of the 24 patients studied, the average treatment was 104.5 （95% CI, 75.71-133.29） times. The average duration of treatment was 12.88 （95% CI, 9.90-15.85） months. The average maintenance treatment time was 11.08 （95 % CI, 2.13-20.04） months. The effective rate （ CR ＋ PR） of PUVA treatment was 88.9%, recurrence rate was 11.1% （n =9）. In the NB-UVB treatment group, the effective rate was 100.0%, and the recurrence rate was 33.3% （n = 6）. In the PUVA followed by NB-UVB （combination therapy） treatment group, the effective rate was 77.8% and the recurrence rate was 55.6% （n = 9）. There were no significant differences among the three groups in terms of number of treatments, treatment duration, maintenance treatment duration, effective rate and recurrence rate （P 〉 0.05）. Conclusions PUVA and NB-UVB are effective and safe in the targeted therapy of early stage mycosis fungoides. The combined therapy of PUVA followed by NB-UVB can reduce the total PUVA dose and risk of developing skin cancer.

关 键 词：淋巴瘤 T细胞 皮肤 真菌病 蕈样 PUVA疗法 紫外线疗法 治疗效果 

分 类 号：R739.5[医药卫生—肿瘤]