MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH
HANOI MEDICAL UNIVERSITY
DINH HUU NGHI
EVALUATION OF TREATMENT RESULTS
AND CHANGES IN SOME IMMUNE FACTORS IN PSORIASIS VULNERABLE PATIENTS EXPOSED TO NARROW-BAND UV RADIATION
DOCTORAL THESIS IN MEDICINE
HANOI - 2021
MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH
HANOI MEDICAL UNIVERSITY
DINH HUU NGHI
EVALUATION OF TREATMENT RESULTS
AND CHANGES IN SOME IMMUNE FACTORS IN PSORIASIS VULNERABLE PATIENTS EXPOSED TO NARROW-BAND UV RADIATION
Specialty: Dermatology Code: 62720152
DOCTORAL THESIS IN MEDICINE
Scientific instructor:
Assoc.Prof.Dr. Nguyen Van Thuong
HANOI - 2021
COMMITMENT
I am Dinh Huu Nghi, a graduate student of the 33rd course of Hanoi Medical University, majoring in Dermatology. I hereby declare that:
1. This is a thesis that I directly conducted under the guidance of Professor Nguyen Van Thuong - Head of Dermatology Department, Hanoi Medical University, Director of Central Dermatology Hospital.
2. This work does not overlap with any other research published in Vietnam.
3. The data and information in the study are completely accurate, honest and objective, and have been confirmed and approved by the research facility.
I take full legal responsibility for these commitments.
Hanoi, June 18, 2021
The author guarantees
(Sign and print full name)
DINH HUU NGHI
LIST OF ABBREVIATIONS
Acronym
English translation | Vietnamese translation | |
APC | Antigen presenting cell | Antibody presenting cells original |
cAMP | Cyclic adenosine monophosphate | |
BN | Patient | |
BB-UVB | Broad band-ultraviolet B | Broadband ultraviolet B |
CD | Cluster of differences | Differentiated cluster |
CLA | Cutaneous - Lymphocyte associated antigen | Cell-associated antigens skin lymphocytes |
COX2 | Cyclooxygenase 2 | |
CTL | Cytotoxic T lymphocytes | Cytotoxic T lymphocytes |
DMARDs | Disease-modifying antirheumatic drugs | Anti-rheumatic drugs joint disease |
DNA | Deoxyribonucleic acid | |
DLQI | Dermatology Life Quality Index | Quality of life index Living by Dermatology |
DOPA | Dihydroxyphenylalanine | |
EDTA | Ethylene Diamine Tetracetate | |
ELISA | Enzyme linked immunoadsorbent assay | Immunoassay technique enzyme-binding |
HATĐ | Maximum blood pressure | |
HATT | Minimum blood pressure | |
HE | Hematoxylin eosin | |
HLA | Human lymphocytic antigen | Leukocyte antigens People |
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ICAM-1
Intercellular adhesion molecule-1 | Cell adhesion molecule – 1 | |
IFN- | Interferon- | |
Ig | Immunoglobulin | Immune globulin |
IL | Interleukin | |
KN - KT | Antigen - antibody | |
LFA-1,3 | Lymphocyte function associated antigen | Binding antigen lymphocyte function |
MCP-1 | Monocyte chemoattractant protein-1 | Chemotaxis protein monocytes-1 |
MED | Minimal erythema dose | Minimum dose of redness |
MHC | Major histocompatibility complex | Host tissue compatibility complex weak |
MTX | Methotrexate | |
mRNA | Messenger ribonucleic acid | messenger RNA |
NB-UVB | Narrow band ultraviolet B | Narrow band ultraviolet B |
NK cells | Natural killer cell | Natural killer cells |
PAS | Schiff's Periodic Acid | |
PASI | Psoriasis area severity index | Scale severity index candle |
PUVA | Psoralen ultraviolet A | |
TCR | T cell receptor | T cell receptor |
Th | T helper | T support |
TGF- | Transforming growth factor-alpha | Growth factor transfer alpha form |
TNF- , | Tumor necrosis factor- , | Tumor necrosis factor |
Ts/Tc | T suppressor/ T cytotoxic | T inhibitor/T toxic |
UV | Ultraviolet | Ultraviolet rays |
INDEX
PROBLEM STATEMENT 1
CHAPTER 1. OVERVIEW 3
1.1. Common psoriasis 3
1.1.1. Medical history 3
1.1.2. Psoriasis situation 3
1.1.3. Pathogenesis of psoriasis vulgaris 3
1.1.4. Clinical characteristics of patients with psoriasis vulgaris 7
1.1.5. Histopathological characteristics 11
1.1.6. Disease progression 11
1.2. The role of cytokines in psoriasis vulgaris 12
1.2.1. IL-17 14
1.2.2. IL-23 18
1.2.3. TNF- 21
1.3. Treatment of psoriasis 23
1.3.1. Psoriasis treatment strategy 23
1.3.2. Evaluation of treatment effectiveness 23
1.3.3. Methods of treating psoriasis 24
1.3.4. Treatment of psoriasis with ultraviolet rays 24
CHAPTER 2. RESEARCH SUBJECTS AND METHODS 35
2.1. Research subjects 35
2.1.1. Diagnostic criteria 35
2.1.2. Patient selection 35
2.2. Research location and time 36
2.2.1. Place of implementation 36
2.2.2. Research time 36
2.3. Research methods 36
2.3.1. Research design 36
2.3.2. Sample size and sampling method 36
2.3.3. Steps to follow 38
2.3.4. Variables and indicators used in the study 44
2.3.5. Materials and techniques used in the study 47
2.4. Data processing 56
2.5. Errors and remedies 56
2.6. Ethics in research 57
CHAPTER 3. RESEARCH RESULTS 59
3.1. Characteristics of research subjects 59
3.1.1. General characteristics of the research group 59
3.1.2. Patient history characteristics 61
3.1.3. Disease triggering factors 63
3.1.4. Clinical characteristics of study group 64
3.1.5. Paraclinical characteristics of patients before treatment 66
3.1.6. Characteristics related to metabolic syndrome 67
3.2. Treatment results of moderate and severe psoriasis vulgaris with narrow band ultraviolet irradiation 68
3.2.1. Clinical treatment results 68
3.2.2. Paraclinical results 86
3.3. Changes in serum levels of IL-17, IL-23, TNF- before and after treatment of moderate and severe psoriasis vulgaris with narrow band ultraviolet 88
3.3.1. Some general characteristics of the cytokine research group 88
3.3.2. Pre-treatment cytokine concentrations and some related factors 90
3.3.3. Changes in cytokine concentrations before treatment and when reaching PASI 75 98
3.3.4. Changes in cytokine concentrations before treatment and when reaching PASI 75 according to patient characteristics 99
3.3.5. The impact of metabolic syndrome on changes in cytokine concentrations 102
CHAPTER 4. DISCUSSION 105
4.1. Characteristics of research subjects 105
4.1.1. General characteristics of the research group 105
4.1.2. Characteristics of patient history 106
4.1.3. Factors that trigger the disease 108
4.1.4. Clinical characteristics of study group 109
4.1.5. Paraclinical characteristics of patients before treatment 110
4.1.6. Characteristics related to metabolic syndrome 110
4.2. Treatment results of moderate and severe psoriasis vulgaris with narrow band ultraviolet 111
4.2.1. Clinical treatment results 111
4.2.2. Paraclinical results 130
4.3. Changes in serum levels of IL-17, IL-23, TNF-α before and after treatment of moderate and severe psoriasis vulgaris with narrowband ultraviolet 132
4.3.1. Some general characteristics of the cytokine research group 132
4.3.2. Pretreatment cytokine concentrations and some related factors .. 133
4.3.3. Changes in cytokine concentrations before treatment and when reaching PASI 75 139
CONCLUSION 148
PROPOSAL 150
PUBLISHED RESEARCH PROJECTS REFERENCES
APPENDIX