Narrow-band Ultraviolet Study Of Clinical Efficacy In Patients With Psoriasis Vulgaris, Serum And Skin Tissue Cytokines

Objective: To observe and to analyze the clinical efficacy of 311nm narrowband UVB (NB-UVB) and 280～320nm broadband UVB (BB-UVB) phototherapy in patients with psoriasis vulgaris, so as to provide an objective basis for selecting NB-UVB to treat psoriasis.Methods: A total of 52 patients with psoriasis vulgaris were treated with 311nm NB-UVB radiation at one side of body and 280～320nm UVB radiation at the other side of body. Erythema, scale, and induration were chosen as the observative parameters before and after the 1st, 2nd, 3rd, and the 4th week treatment. The efficacy was evaluated by ESI score to analyze the remission rates of lesions and cure rates, and spss 11.5 software was used for statistical analysis.Results: ESI scores of 50 patients involved were assessed before the treatment and 1, 2, 3, and 4 weeks after the treatment. Pre-treatment ESI scores were 15.95±6.32. After NB-UVB radiation, in the 1st, 2^nd, 3rd and 4th week, ESI scores were 10.32±5.43, 6.85±6.41, 3.13±2.52 and 1.27±2.36, remission rates of lesions by NB-UVB were (35.43±8.62) %, (59.5±10.57)%, (82.29±15.03) % and (90.42±9.97) %, and the numbers of patient clear were 1, 18, 26,42 and clear rates were 2%, 36%, 52%, 88% respectively. In contrast, after radiation of BB-UVB, in 1^st,2nd,3^rd and 4th week, ESI scores were 12.36±6.58, 9.57±55.32, 5.14±3.68 and 3.08±3.75, remission rates of lesions were (31.02±12.50) %, (51.27±13.67) %, (73.34±20.38) % and (83.86±8.59) %, and the numbers of patient clear were 0, 9, 15, 35 and clear rates were 0, 18%, 30%, 70% respectively. After 1 week of treatment, ESI scores of NB-UVB group decreased significantly(p＜0.05), while which of BB-UVB group had no significant difference (p＞0.05) .In the 2^nd,3^rd and 4th week, compared with the 1st week, ESI scores, remission rates of lesions and cure rates in both groups had significant difference(p＜0.05),and with the duration of treatment, remission rates of lesions and clear rates increased and ESI scores decreased significantly. After 1 week of treatment, ESI scores of NB-UVB group decreased more significantly than which of BB-UVB group (p＜0.05), remission rates of lesions increased more significantly than which of BB-UVB group(p＜0.05), and between NB-UVB and BB-UVB group, there was no significant difference of clear rates (p＞0.05 ). After 2,3,4 weeks of treatment, ESI scores of NB-UVB group decreased more significantly than which of BB-UVB group (p＜0.05), and remission rates of lesions and clear rates of NB-UVB group compared with which of BB-UVB group increased more significantly(p＜0.05).Conclusion: Compared to BB-UVB, NB-UVB takes shorter time and has higher cure rate, it is superior to BB-UVB in term of treatment of psoriasis vulgaris. Objective: This study was designed to observe the effects of 311nm NB-UVB and 280nm～320nm BB-UVB on the serumal soluble TNF-R1 receptor 1 (sTNF-R1), IFN-γand IL-4 in the patients with psoriasis vulgaris, and to investigate the level of IFN-γand IL-4 in lesions of patients treated with 311nm NB-UVB, so as to explore its possible theraputic mechanism with the clinical efficacy..Method: 60 cases with psoriasis vulgaris were divided into 3 groups randomly, NB-UVB group, BB-UVB group, and control group. Each group included 20 patients was given phototherapy 3 times per week, and 4 weeks of treatment totally, and control group was not given any phototherapy. The severity of psoriasis was evaluated by PASI score, and serumal sTNF-R1, IFN-γand IL-4 were detected by ELISA before and after treatment, and the expression of IFN-γand IL-4 in skin lesions were analyzed by immunohistochemistry and image-analysis system before and after treatment.All the results were shown as IOD, and compared with the normal value.and then analyzed statistically by spss 11.5 software. significantly to 2.65±1.36, 5.32±3.28, 9.99±7.27 respectively in 3 groups, and which of NB-UVB group was the lowest (p＜0.05).Serum results:sTNF-R1: The levels of serumal sTNF-R1 of 3 groups were 2.06±0.33 ng/ml, 2.11±0.35 ng/ml, 2.10±0.31 ng/ml respectively, all of which were higher than that in normal volunteer's serum(1.47±0.21 ng/ml) before treatment(p＜0.05),and decreased significantly after treatment to 1.57±0.33 ng/ml, 1.78±0.22 ng/ml, 1.92±0.17 ng/ml respectively (p＜0.05). The level of serumal TNF-R1 in NB-UVB group decreased more significantly than that in BB-UVB group and in control group (p＜0.05).IFN-γ: The levels of serumal IFN-γof 3 groups were34.16±5.50 pg/ml, 34.21±7.92 pg/ml, 34.21±6.25 pg/ml respectively, all of which were higher than normal volunteers'(5.46±1.04 pg/ml) (p＜0.05) , and decreased significantly to 12.46±1.46 pg/ml, 23.81±2.54 pg/ml, 27.74±1.73 pg/ml respectively after treatment(p＜0.05). The level of IFN-γ, of NB-UVB group decreased more significantly than that of BB-UVB group and control group (p＜0.05). IL-4: The levels of serumal IL-4 in 3 groups were 6.19±2.39 pg/ml, 6.45±3.42 pg/ml, 6.78±3.12 pg/ml respectively, and showed no significant difference among the study groups and normal volunteers'(5.75±2.26 pg/ml) before treatment (p＞0.05) .After treatment, the levels of IL-4 of the 3 study groups were 5.63±1.93 pg/ml, 5.55±1.58 pg/ml, 6.71±4.04 pg/ml respectively and no significant change existed (p＞0.05) . Immunohistochemistry and image-analysis results: IFN-γ: The level of IFN-γin lesions increased before treatment in both NB-UVB and control groups compared to normal skin(p＜0.05), and IOD were (28.163±6.501)×10², (28.892±4.251)×10² , (6.174±2.012)×10 respectively, and decreased significantly to (7.021±1.892)×10² , (7.021±1.892)×10² after treatment(p＜0.05), and which of NB-UVB group decreased more significantly than that of control group(p＜0.05).IL-4: The IOD of IL-4 were (5.263±3.204)×10², (4.991±4.257)×10² , (4.253±2.849)×10² respectively before treatment, and which had no significant difference with the normal group. After treatment, the IOD of IL-4increased to ( 15.762±2.325 )×10² , (10.754±3.573)×10² (p＜0.05), and which increased more significantly in NB-UVB group than that in control group(p＜0.05).Conclusion- NB-UVB is superior to BB-UVB in improvement of PASI score and decrease of serumal sTNF-R1, IFN-γin term of the treatment of psoriasis vulgaris. At the same time, NB-UVB has a therapeutic effect on psoriasis vulgaris by regulating the level of IFN-γin serum and IFN-γ,IL-4 in lesions to improve the imbalance of Thl and Th2.