Objective:To investigate the changes of serum mannose-binding lectin (MBL) and regulatory T cell(Treg) and their cytokines in patients with vitiligo at different stages and types, and their correlation with their activity.Methods:A total of 50 patients with vitiligo diagnosed in Zhongshan Hospital Fudan University from October 2020 to June 2021 were selected. According to the clinical staging criteria of vitiligo, they were divided into stable stage (25 cases) and progressive stage (25 cases). According to the clinical classification principle, they were divided into segmental type (14 cases) and non-segmental type (36 cases). Another 25 healthy subjects were selected as the control group. The changes of MBL, CD4 + CD25 + CD127 -Treg, related factors cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), interleukin (IL)-10 and transforming growth factor-β(TGF-β) in peripheral blood of patients with vitiligo were compared among the control group and different stages and types, and the correlation between vitiligo disease activity score (VIDA) and related indicators was analyzed. Results:Compared with the control group, the levels of serum MBL, CD4 + CD25 + CD127 -Treg cells and related factor CD4 + CD25 + CD152 + (CTLA-4) in peripheral blood mononuclear cell(PBMC) of patients with stable and progressive vitiligo were significantly lower, while the level of TGF-β was significantly higher[ng/mL: (4.76±0.56)vs(4.32±0.56)vs(3.80±0.43), %: (7.51±3.28)vs(6.21±1.52)vs(4.02±0.68), %: (4.04±1.84)vs(4.00±2.04)vs(2.36±1.08), ng/mL: (32.17±14.49)vs(50.79±22.40)vs(66.40±27.04), F=20.78, 17.12, 7.88, 15.27, all P values <0.05]. However, there was no significant difference in IL-10 expression among the groups( P>0.05). Compared with the stable phase, the CTLA-4 levels of MBL, Treg cells and related factors decreased significantly, while the level of TGF-β increased significantly ( P=0.001, 0.001, 0.003). Compared with the control group, the levels of serum MBL and CD4 + CD25 + CD127 -Treg cells in patients with segmental vitiligo and non-segmental vitiligo were significantly lower, and the expression of TGF-β was significantly higher[ng/mL: (4.76±0.56)vs(3.95±0.61)vs(4.14±0.55), %: (7.51±3.28)vs(5.49±1.48)vs(4.97±1.65), ng/mL: (30.89±17.88)vs(58.08±30.14)vs(59.32±23.99), F=12.26, 9.19, 11.96, all P values <0.05)]. There was no significant difference in the expression of CD4 + CD25 + CD152 + (CTLA-4) and IL-10 among the groups ( P>0.05). VIDA score was negatively correlated with MBL and Treg, and positively correlated with TGF-β in patients with vitiligo( r=-0.28、-0.36、0.31, all P values <0.05). Conclusion:MBL, Treg and their cytokines CTLA-4 and TGF-β are closely related to the pathogenesis and activity of vitiligo.

目的:探讨焦虑、抑郁对白癜风患者药物治疗效果的影响.方法:培训过的医务处干事作为心理研究员依据汉密尔顿焦虑量表14项(HAMA-14)和汉密尔顿抑郁量表24项(HAMD-24)在白癜风患者治疗前对其进行焦虑、抑郁评分.皮肤科医师依据病情及患者治疗意愿对白癜风患者进行分组,分为单纯外涂药物治疗(外涂治疗组,n=72)和外涂药物+口服中药或西药联合治疗(联合治疗组,n=128).将联合治疗组进一步分为联合活血合剂组(n=47)、联合甘草酸苷组(n=35)、联合活血合剂+甘草酸苷组(n=27)及联合泼尼松组(n=19).活血合剂为复旦大学附属中山医院自制中药制剂,30 mL/次、每日2次口服;甘草酸苷50 mg/次,每日3次口服;泼尼松20 mg/次、每日1次口服.进行为期3个月的临床治疗观察,对各组进行疗效指数评估,分析焦虑、抑郁评分和疗效指数的相关性.结果:纳入200例,男性69例、女性131例.外涂治疗组稳定期65例,进展期7例;联合治疗组稳定期44例,进展期84例.200例患者均完成了为期3个月的临床观察,观察期内均未出现严重不良反应.Spearman相关系数分析结果显示,焦虑、抑郁与各治疗方法疗效指数均负相关(P<0.05).结论:对于白癜风患者,无论是单纯应用外涂药物还是外涂药物联合口服中药或西药联合治疗,焦虑、抑郁状态均会降低疗效.

目的:观察基于祛风理气活血的中药基础方联合常规西药治疗白癜风的有效性、安全性及临床可行性,为在西医综合型医院推广中西医病症结合治疗白癜风提供依据.方法:将218例白癜风患者分为病例组126例(采用中药基础方联合常规西药治疗),对照组92例(采用单纯西药治疗).比较两组疗效、白斑消退率、不良反应,并分层分析.结果:病例组总有效率62.70％(79/126),对照组总有效率41.30％(38/92),两组差异有统计学意义(P=0.001).病例组白斑消退率为(38.62±19.11)％,对照组为(20.94±19.51)％,两组差异有统计学意义(P<0.001).分层分析显示,病例组进展期和稳定期总有效率和白斑消退率均高于对照组(P<0.05).两组系统应用糖皮质激素患者的总有效率和白斑消退率差异无统计学意义.病例组不良反应发生率为7.14％,对照组为6.52％,两组差异无统计学意义.不良反应均以胃肠道反应为主,能耐受.结论:中药基础方联合常规西药治疗白癜风疗效肯定、安全性良好、可行性强,值得临床推广.

目的 观察中药复方丹归活血合剂治疗白癜风的有效性与安全性,开展院内制剂规范化临床研究.方法 采用前瞻性随机双盲对照方法,将171例白癜风患者分为中药组(丹归活血合剂口服加0.05％卤米松乳膏外用,89例)和对照组(安慰剂口服加卤米松乳膏外用,82例),3个月后评价色素情况.结果 中药组总有效率57.30％,对照组总有效率40.24％,两组差异有显著统计学意义(P＜0.05);中药组白斑消退率为35.09％,而对照组为18.48％,两组差异有显著统计学意义(P＜0.001).不良反应发生率中药组为6.74％,对照组为6.10％,主要是胃肠道反应,能耐受,两组差异无统计学意义(P＞0.05).结论 丹归活血合剂治疗白癜风疗效肯定,安全性良好.

Increased expression of the cytokine interferon (IFN)-γ plays a pivotal role in vitiligo-induced depigmentation. However, the major source of IFN-γ in vitiligo patients and the mechanisms underlying melanocyte destruction are unknown. In this study, a large number of skin infiltrating IFN-γ+ cells and CD8+ T cells were detected in progressive vitiligo. Among the peripheral blood mononuclear cells (PBMCs) of vitiligo patients, CD8+ cytotoxic T lymphocytes (CTLs) that express IFN-γ exhibited significant expansion, which suggests that activated CTLs are the main source of increased IFN-γ in progressive vitiligo. An in vitro analysis demonstrated that IFN-γ inhibits melanogenesis in primary cultured human melanocytes by altering melanogenic enzyme mRNA expression and, more importantly, that IFN-γ directly induces melanocyte apoptosis. Our data indicate that vitiligo pathophysiology may be linked to globally activated CD8+ CTL subpopulations, which produce increased IFN-γ and induce melanocyte dysfunction and apoptosis.

Recent reports have demonstrated that endothelial cells are involved in vascular inflammatory injury in systemic sclerosis (SSc) and interleukin-17A (IL-17A) plays a crucial role in the pathogenesis of SSC. However, little is known about the effects of IL-17A on endothelial cell inflammation in SSC. The aim of our study was to investigate the role of IL-17A in endothelial inflammation. Here, we showed that IL-17A mRNA and protein levels were augmented in the peripheral blood and more IL-17+ lymphocytes infiltrated in the perivascular areas in the involved skin of SSC patients. SSC patient serum induced chemokine and adhesion molecule expression in HUVECs, which was blocked by IL-17A neutralization. IL-17A alone induced chemokine and adhesion molecule expression and promoted T cell-HUVEC adhesion. Extracellular signal-regulated kinase (ERK) inhibition and IL-17A neutralization prominently inhibited chemokine and adhesion molecule expression and blocked T cell-HUVEC adhesion. IL-17A derived from SSC patient serum mediated endothelial cells inflammation by up-regulating chemokines and adhesion molecules, which was blocked by ERK inhibition. These data imply that ERK signal pathway might play a key role in the progression of endothelial injury induced by IL-17A in SSC.

Melanocyte-specific CD8(+) cytotoxic T lymphocytes (CTLs) play a pivotal role in vitiligo-induced depigmentation. Yet, the mechanisms underlying the high frequency of generalized autoimmune disorders associated with generalized vitiligo (GV) are unknown. We hypothesized that an imbalance between activated CD8(+) CTLs and regulatory T cells (Tregs) exists in patients with GV . Assessment of the circulating CD8(+) CTLs and Tregs by flow cytometric analysis revealed an obvious expansion of CD8(+) CTLs and a concomitant decrease in Treg cells in GV patients. The percentages of skin infiltrating CD8(+) CTLs and Tregs were evaluated by immunohistochemistry and revealed dramatically increased numbers of both CD8(+) CTLs and Tregs in the perilesional skin of GV patients. However, peripheral Tregs were impaired in their ability to suppress the proliferation and cytolytic capacity of autologous CD8(+) T cells, suggesting that a functional failure of Tregs and the hyper-activation of CD8(+) CTLs may contribute to progressive GV. Our data indicate that reduced numbers and impaired function of natural Tregs fail to control the widespread activation of CD8(+) CTLs, which leads to the destruction of melanocytes and contributes to the elevated frequency of various associated autoimmune diseases. This knowledge furthers our understanding of the mechanisms of immune tolerance that are impaired in GV patients and may aid in the future development of effective immunotherapy for GV patients.

<正>随着医学模式的转变,医疗措施目的已从单纯的躯体疾病治疗逐渐转移到全面提高患者的生活质量。性病作为影响公众健康的重要疾病,不但给患者带来躯体痛苦,而且还对其心理和社会适应方面造成显著影响,如何提高其生活

为评价咪唑斯汀治疗慢性特发性荨麻疹的疗效和安全性，我们采用随机开放平行对照的方法，对60例慢性特发性荨麻疹进行临床研究。患者随机分成两组，分别接受咪唑斯汀或氯雷他定治疗，疗程28天。结果表明，咪唑斯汀能有效缓解慢性特发性荨麻疹患者的瘙痒症状，能有效减少风团的数目与减小风团的直径。咪唑斯汀治疗慢性特发性荨麻疹的有效率为93.10％。治疗过程未见严重不良反应。结果显示：咪唑斯汀治疗慢性特发性荨麻疹疗效可靠，安全性好。