| Background Psoriasis is a common clinical chronic inflammatory disease with epidermal cell hyperplasia, vascular neonatal disorders and immune cell infiltration which is not only the skin damage, but also a systemic inflammatory response.The cause of psoriasis is closely related to the abnormal activation of T cells, especially with Th17 cells and related inflammatory factors.Psoriasis is characterized by unknown cause, long duration, recurrent and systemic involvement,affecting the patients on physical and psychological health and the quantity of life.Narrow-spectrum ultraviolet(NB-UVB) light radiation energy concentrated in the 311-313nm band has a fast onset,the exact effect and less adverse reactions and widely used in clinical.The efficacy of NB-UVB is closely related to the irradiation parameters and the period of treatment is 1-3 months.However, some patients often can not regulate the treatment and delay the disease because of no sufficient time.The preliminary exploration of the optimization of the irradiation program laid the foundation for the clinical experiment.Purpose To observe the effect of different irradiation regimens of NB-UVB (optimal regimen and conventional regimen) on the clinical efficacy and IL-23/Th17 cell axis in peripheral blood and skin lesions of psoriasis vulgaris.The optimization scheme has been further demonstrated to be effective, safe and feasible.Methods A total of 80 patients with psoriasis vulgaris were randomly divided into experimental group and control group.All patients were treated by whole body NB-UVB radiation. For experimental group,0.07J/cm2 was used as the dose increment in once a day treatment.while Control group underwent once per two days and add 0.1 J/cm2.Two groups started at 0.4 J/cm2 and were treated for 40 days.The efficacy was evaluated before and after 10days,20days,30days and 40days treatment according to the proportion of psoriasis area and severity index (PASI) ,while calculating the time required and recording the adverse reactions during irradiation.Increase dose was adjusted according to erythema. The levels of IL-23, IL-17 and IL-22 in peripheral blood were measured by ELISA before and 20 days after treatment. The expression of IL-23, IL-17 and Ki67 was detected by immunohistochemistry.Results :①Clinical efficacy:The PASI score of the experimental group and the control group was 21.96±3.63and20.73 ±3.15 p>0.05),which was comparable.The PASI score was 5.88 ±3.32 and 10.15 ±2.92 after treatment, and the two groups were effective,but the experimental group was better than the control group (p<0.05).After 40 days treatment,the effective rate was 87.5% in the experimental group and 75% in the control group, the difference was statistically significant (p=0.028).The efficacy of the two groups of patients was also different at the same time.The improvement rate of the experimental group was 38.2±11.8,56.2±10.5,69.2±12.4,76.6±11.5 at 10 days, 20 days,30 days and 40 days respectively, which was significantly higher than that of the control group at the same time point 21.1±9.6, 39.6±10.4, 51.5±11.2, 61.8±14.4(p=0.032,p<0.001,p=0.003,p=0.005).There was no significant difference in the cumulative dose between the two groups at the same level of treatment (improvement,efficacy and cure) (p=0.611, p=0.105, p=0.066).But the treatment time required in the experimental group was much less than that in the control group (p<0.05).There was no significant difference between the two groups in the cumulative dose of 26.89 ±6.08 and 28.52 ±5.48 at the end of treatment (p=0.8899).②IL-23/Th17 cell axis:There was no significant difference between the experimental group with IL-23 (5.74±1.63) pg/ ml,IL-22 (30.69 ±7.99) pg/ml,IL-23 (92.49±11.12) pg/ml and control group with IL-17(5.75±1.87) pg/ml、IL-22 (30.20±9.63) pg/ml、IL-23 (93.48±9.63) pg/ml before treatment. In the experimental group,IL-17 decreased to (2.57 ± 0.98) pg/ml for 20 days,which was significantly different from that before treatment (p=0.0006).While the level of IL-17 in the control group was not significantly changed (p=0.3 89).After treatment,IL-22 (13.18 ± 3.97) and IL-23 (30.62 ± 8.59) in the serum of the experimental group and IL-22 (17.99±7.01) pg/ml IL-23 (41.14± 11.73) pg /ml in control group were lower than those before treatment (p<0.0001). But the decrease of IL-22 and IL-23 in the experimental group was more significant than that in the control group (p=0.0335; p=0.0052).IL-17 (12.6 ±2.82) and IL-23 (13.6 ±2.59) in the treatment group were significantly lower than IL-17 (19.6±3.25) and IL-23 (21.0士2.65) in the control group, The difference was statistically significant (p<0.05).However, there was no significant change in IL-17 and IL-23 expression in the lesion after treatment for 20 days (p=0.106, p=0.063).The expression of Ki67 (22.3 ±4.49,21.1 ±5.73) in the lesion was significantly lower than that before treatment (42.6±5.25, 43.8 ±6.63) in the two groups (p<0.05).Conclusion: The recommended exposure regimen is a fixed starting dose, once daily,with an increment of 0.07J/cm2 in the treatment of psoriasis vulgaris with NB-UVB.This program can quickly control the disease in a short time, compared with the current conventional treatment without greater cumulative dose and more adverse reactions to ensure the effectiveness of rapid treatment and safety. |
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