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櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒24nomaJ．JNatlCancerInst2001931638-1643．25GuntherKLeierJHenningGetal．Predictionoflymphnodeme-tastasisincolorectalcarcinomabyexpressionofchemokinereceptorCCR7J．IntJCancer2005116726-733．26MashinoKSadanagaNYamaguchiHetal．Expressionofchemo-kinereceptorCCR7isassociatedwithlymphnodemetastasisofgas-triccarcinomaJ．CancerRes2002622937-2941．27RichmondAThomasHG．Purificationofmelanomagrowthstimulato-ryactivityJ．JCellPhysiol1986129375-384．28BalentienEMufsonBEShattuckRLetal．EffectsofMGSA/GROalphaonmelanocytetransformationJ．Oncogene199161115-1124．29AnisowiczAMessineoMLeeSWetal．AnNF-kappaB-liketran-scriptionfactormediatesIL-1/TNF-alphainductionofgroinhumanfibroblastsJ．JImmunol1991147520-527．30HaskillSPeaceAMorrisJetal．Identificationofthreerelatedhu-manGROgenesencodingcytokinefunctionsJ．ProcNatlAcadSci1990877732-7736．31ColomboMPMaccalliCMatteiSetal．ExpressionofcytokinegenesincludingIL-6inhumanmalignantmelanomacelllinesJ．MelanomaRes19922181-189．32GravesDTBarnhillRGalanopoulosTetal．Expressionofmonocytechemotacticprotein-1inhumanmelanomainvivoJ．AmJPathol19921409-14．33RobledoMMBartolomeRALongoNetal．ExpressionoffunctionalchemokinereceptorsCXCR3andCXCR4onhumanmelanomacellsJ．JBiolChem200127645098-45105．34PayneASCorneliusLA．TheroleofchemokinesinmelanomatumorgrowthandmetastasisJ．JInvestDermatol2002118915-922．35KawadaKSonoshitaMSakashitaHetal．PivotalroleofCXCR3inmelanomacellmetastasistolymphnodesJ．CancerRes2004644010-4017．36Longo-ImedioMILongoNTrevinoIetal．ClinicalsignificanceofCXCR3andCXCR4expressioninprimarymelanomaJ．IntJCanc-er2005117861-865．37SagerRAnisowiczAPikeMCetal．StructuralregulatoryandfunctionalstudiesoftheGROgeneandproteinJ．Cytokines1992496-116．38Shattuck-BrandtRLRichmondA．EnhanceddegradationofI-kap-paBalphacontributestoendogenousactivationofNF-kappaBinHs294TmelanomacellsJ．CancerRes1997573032-3039．39SchadendorfDMollerAAlgermissenBetal．IL-8producedbyhu-manmalignantmelanomacellsinvitroisanessentialautocrinegrowthfactorJ．JImmunol19931512667-2675．40GutmanMSinghRKXieKetal．Regulationofinterleukin-8ex-pressioninhumanmelanomacellsbytheorganenvironmentJ．CancerRes1995552470-2475．41MoralesJHomeyBVicariAPetal．CTACKaskin-associatedche-mokinethatpreferentiallyattractsskin-homingmemoryTcellsJ．ProcNatlAcadSciUSA19999614470-14475．42KawadaKSonoshitaMSakashitaHetal．PivotalroleofCXCR3inmelanomacellmetastasistolymphnodesJ．CancerRes2004644010-4017．2012-09-03【】。。。510515【】。localizedsclerodermasystemicsclerosisSSc。。。【】【】R751.05【】A【】1672-6170201301-0021-06AdvancesontreatmentofsclerodermaZENGKangLAIKuanCHENPing-jiaoDepartmentofDer-matologyandRheumatologyNanfangHospitalSouthenMedicalUniversityGuangzhou510515China【Abstract】SystemicsclerosisSScisandconnectivetissuediseasecharacterizedbyfibrosisofskinandinternalorgans．Local-izedsclerodermaonlyinvolveskin．Thepathogenesisofthessdiseasesisnotclear．Thoughnewtherapeuticmethodskeepcomingoutandadoptednospecifictreatmentisidentified．Treatmentsandadvancesintherapeuticstudyoflocalizedsclerodermaandsystemicsclerosisarereviewedinthispaper．【Keywords】SclerodermaTreatmentAdvances1∶3。lo-calizedsclerodermamorphealinearscleroderma。guttatemorphea、1220131101plaque-likemorphea、generalizedmorphea、—morphea-lichensclerosisetatrophicusoverlap、PasiniPieriniatrophodermaofPasiniandPierini、morpheaprofunda、bullousmorphea、disablingpanscleroticmorphea。systemicsclerosisSScSSc、、progressivesystemicsclerosisPSSacrosclerodermadiffusesclerodermaCRESTcalci-nosiscutisCRaynaudphenomenonResophagealdysfunctionEsclerodactylyStelangiectasiaT。、3。、1、2、34、90%、。、、、、。、、、、、。11.15～7Photo-therapy。、8、。Nar-rowbandultravioletBNBUVB/1broadbandul-travioletA/ultravioletA-1BBUVA/UVA-1。10～2020～30。9UVA-1。10medium-doseMDUVA1。NBUVBUVA1。1.2、、methotrexateMTXMTX。MTX。Fett11119MTX67MTX。MTX0.3～0.4mg/kg·w15～25mg/w9479%。MTX、。“”“”。1.30.005%120.1%13、。D3、。T、。1.4、、D-、-γ。、A、。MRI。、。2SSc2.1D-、、、。①D-DPA2060。5。。Derk14750mg/d、、。②22201311016mg2/3/61。。③SSc。、、SSc。0.5～1.5mg/d3。SSc、。2.2SSc。、、、、、。15、、、ACEI、16、。2.3、2.3．1SSc、、、、。。、。2.3．2CyclophosphamideCTXCTXT、BCD4/CD8T。CTXSSc。、、17CTXInterstitiallungdiseaseinsystemicsclerosisSSc-ILDCTX1～2mgkg·d1。181824。CTX。、、、19CTX1。。Nannini20MetaCTX。2.3．3mycophenolatemofetilMMFMMFIMPDH21。MMFT、BIIIMPDH。MMFCTX。SScMMF62214.2%1223。524MMF。25dcSScMMF4～6DLCO。2615dcSSCMMF12RodnanmRSS。Meta27MMF、。2.3．4、MTX、A、MTXSScSSc。A、SSc。2g/kgintravenousim-munoglobulinIVIGSSc。2.42.4．1RituximabCD20IgG1、、B。、、。SSc3220131101。2814dcSScRituximab。1。Rituximab。“”。2.4．2-α、-β、-αAnti-TNF-αinfliximab、。29TNF-αetanercept。29infliximabdcSSc。-βTGF-βSSc、、30TGF-βanti-TGF-βantibodySSc。imatinibSSc。IIa、31SSc。2.5322、。。33。2.6hematopoieticstemcelltransplantationHSCTHSCTHSCT。HSCT3435。/3637SScCTX、69%mRss30。17%。5737、、SSc、8.7%92%6HSCTSSc。35%92.2～48.7。Ⅱ38HSCT19dcSSc、CTXantithymocyteglobulinATG58%16%1579%278.9%。343923%mRss、。forcedvitalcapacityFVCDLCO6.04%。1174。、、、Ⅱ40CTXHSCTSSc。。、、、、。3、。、、。【】1PrinzJCKutasiZWeisenseelPetal．Borrelia-associatedearly-onsetmorpheaaparticulartypeofsclerodermainchildhoodandadolescencewithhightiterantinuclearantibodiesResultsofaco-hortanalysi