摘要目的 观察308 nm准分子激光联合他扎罗汀凝胶治疗斑块状银屑病的临床疗效和安全性.方法 采用数字表法将72例斑块状银屑病患者随机分为联合治疗组、他扎罗汀组和308 nm准分子激光组,每组24例.他扎罗汀组夜间外涂1次他扎罗汀凝胶;308 nm准分子激光组应用308 nm准分子激光照射治疗;联合治疗组联合应用以上两种治疗方法.分别在治疗第2、4、8周时,对3组患者进行疗效判定,观察银屑病皮损面积和严重程度指数(PASI评分)、有效率及不良反应等情况.结果 联合治疗组在治疗4和8周时PASI评分(4.75±0.44,2.35±0.37)均低于308 nm准分子激光组(6.75±0.57,4.67±0.36)和他扎罗汀组(8.75±0.48,6.48±0.45),且联合治疗组治疗8周时PASI评分明显低于治疗2周及4周时,差异均有统计学意义(均P＜0.05).联合治疗组在治疗2、4和8周时的有效率[29.1％(7例)、66.7％(16例)和87.5％(21例)]均高于他扎罗汀组[12.5％(3例)、41.7％(10例)和62.5％(15例)]和308 nm准分子激光组[20.8％(5例)、50.0％(12例)和75.0％(18例)],差异均有统计学意义(均P＜0.05).三组患者观察期间均未发生系统不良反应,局部不良反应发生率联合治疗组16.7％(4例)、他扎罗汀组12.5％(3例)、308 nm准分子激光组12.5％(3例),3组比较,差异无统计学意义(P＞0.05).结论 308 nm准分子激光联合他扎罗汀凝胶治疗斑块状银屑病的疗效优于单独应用他扎罗汀凝胶或308 nm准分子激光.

abstractsObjective To investigate the clinical efficacy and safety of 308-nm excimer laser combined with tazarotene gel for the treatment of plaque psoriasis.Methods Seventy-two patients with plaque psoriasis were randomly and equally divided into three groups according to a random number table:tazarotene group topically applying tazarotene gel once per night,308-nm excimer laser group treated with 308-nm excimer laser,combination group treated with both tazarotene gel and 308-nm excimer laser.Clinical efficacy was evaluated according to psoriasis area and severity index (PASI) score and response rate,and safety according to adverse reactions at week 2,4 and 8 after starting treatment.Results PASI score was significantly lower in the combination group at week 4 and 8 (4.75 ± 0.44 and 2.35 ± 0.37 respectively) than in the 308-nm excimer laser group (6.75 ± 0.57 and 4.67 ± 0.36 respectively,both P ＜ 0.05) and tazarotene group (8.75 ± 0.48 and 6.48 ± 0.45 respectively,both P ＜ 0.05),and significantly lower in the combination group at week 8 than at week 2 and 4 (both P ＜ 0.05).A significant increase was observed in the response rate at week 2,4,and 8 in the combination group (29.1％ (7/24),66.7％ (16/24) and 87.5％ (21/24) respectively) compared with the tazarotene group (12.5％ (3/24),41.7％ (10/24) and 62.5％ (15/24) respectively,all P＜ 0.05) and 308-nm excimer laser group (20.8％ (5/24),50.0％ (12/24) and 75.0％ (18/24) respectively,all P＜ 0.05).No systemic adverse reactions were observed in any of the 3 groups during the study,and there was no significant difference in the incidence of local adverse reactions between the combination group,tazarotene group and 308-nm excimer laser group (16.7％ (4/24) vs.12.5％ (3/24) vs.12.5％ (3/24),P ＞ 0.05).Conclusion The efficacy of 308-nm excimer laser combined with tazarotene gel is superior to that of tazarotene gel or 308-nm excimer laser alone in the treatment of plaque psoriasis.