Russian Journal of Skin and Venereal DiseasesRussian Journal of Skin and Venereal DiseasesРоссийский журнал кожных и венерических болезней1560-95882412-9097Eco-Vector6222710.17816/dv62227DERMATOLOGYДЕРМАТОЛОГИЯResearch ArticlePathogenetic justification of the use of simvastatin in the complex therapy of vitiligoПатогенетическое обоснование применения симвастатина при комплексной терапии витилигоhttps://orcid.org/0000-0002-7496-7551DavletshinaAlina Yu.ДавлетшинаАлина Юрьевна
Russian Federation
alina-mitrakova@yandex.ruhttps://orcid.org/0000-0002-4580-61934784-9730LomonosovKonstantin M.ЛомоносовКонстантин Михайлович
Russian Federation
lamclinic@yandex.ruI.M. Sechenov First Moscow State Medical University (Sechenov University)Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)150620212432272420103202121082021Copyright ©; 2021, Eco-VectorCopyright ©; 2021, ООО "Эко-Вектор"2021Eco-VectorООО "Эко-Вектор"https://rjsvd.com/1560-9588/article/view/62227

BACKGROUND: Vitiligo is a chronic acquired disease with a genetic predisposition to pigmentation disorder caused by the destruction of skin melanocytes, leading to hypopigmentation. The effectiveness of currently available methods of treatment of vitiligo, on average, is about 40%. Therefore, it is necessary to search for new effective and safe methods of vitiligo therapy, characterized by minimal risk of side effects, and financial costs of the patient. Simvastatin inhibits cholesterol biosynthesis by inhibiting HMC-CoA reductase. In addition to lowering cholesterol, statins have pleiotropic effects, namely, they inhibit various inflammatory mediators and cytokines, activate the antioxidant system, and reduce the level of active forms of oxygen in melanocytes.

AIMS: To develop a pathogenetic therapeutic complex using simvastatin for patients with vitiligo.

MATERIALS AND METODS: To participate in the study, 81 patients with vitiligo were examined. Each patient was determined by the form and stage of the disease. The effectiveness of therapy in the groups was evaluated by assessing the area of repigmentation. The first group received treatment ― simvastatin in combination with UVB therapy 311 nm, the second group-UVB therapy 311 nm. Studies of cytokines were carried out using enzyme immunoassay. Study of the oxidative status using high-performance liquid chromatography-mass spectrometry. Statistical processing of the research materials was carried out using the SPSS Statistics software package.

RESAULTS: The combined method of therapy with the inclusion of simvastatin showed the following clinical results: 6 (12%) had a pronounced positive effect; improvement ― in 34 (69%) patients. Dynamics of the immune profile: decrease in IL-6 from 10±1 to 8.1±0.6; TNF-α from 18.8±2.1 to 12.9±1.1; increase in IL-10 from 3.2±0.4 to 7.3±0.3. Dynamics of the oxidative profile: malondialdehyde 1.7±0.12 to 1.48±0.11, 8-oxo-DG 0.30±0.03 to 0.23±0.02, SOD 170±3 to 207±7, glutathione 697±36 to 942±32.

CONCLUSION: The combined method of vitiligo therapy with the inclusion of simvastatin is effective and safe, leading to stabilization of the process, clinical improvement and a pronounced effect of therapy in 82% of patients. It also has an immune-correcting effect and normalizes the indicators of the oxidative profile.

Обоснование. Витилиго ― хроническое приобретённое заболевание с генетической предрасположенностью к нарушению пигментации, вызванное разрушением меланоцитов кожи с последующей гипопигментацией. Эффективность имеющихся в настоящее время методов лечения витилиго составляет в среднем около 40%, поэтому необходим поиск новых эффективных и безопасных методов терапии витилиго, характеризующихся минимальным риском побочного действия и финансовыми затратами пациента. Симвастатин подавляет биосинтез холестерина за счёт ингибирования ГМГ-КоА-редуктазы. Помимо снижения уровня холестерина, статины обладают плейотропным эффектом, а именно ингибируют различные медиаторы воспаления и цитокины, активируют антиоксидантную систему и снижают уровень активных форм кислорода в меланоцитах.

Цель ― разработать патогенетический терапевтический комплекс с применением симвастатина для больных витилиго.

Материал и методы. В исследовании приняли участие больные витилиго (n=81). Каждому пациенту определяли форму и стадию заболевания. Эффективность терапии в группах оценивали путём измерения площади репигментации. Первая группа получала лечение симвастатином в сочетании с УФБ-терапией 311 нм, вторая группа ― только УФБ-терапию 311 нм. Концентрацию цитокинов определяли иммуноферментным анализом, оценку оксидативного статуса выполняли с помощью высокоэффективной жидкостной хроматографии-тандемной масс-спектрометрии.

Результаты. Комбинированный метод терапии с включением симвастатина показал следующие клинические результаты: у 6 (12%) пациентов отмечен выраженный положительный эффект, у 34 (69%) ― улучшение.

Динамика показателей иммунного профиля: снижение IL-6 с 10±1 до 8,1±0,6 пг/мл, TNF-α с 18,8±2,1 до 12,9±1,1пг/мл; повышение IL-10 с 3,2±0,4 до 7,3±0,3 пг/мл. Динамика оксидативного профиля: МДА с 1,7±0,12 до 1,48±0,11 нмоль/мл, 8-oxo-dGс с 0,30±0,03 до 0,23±0,02 нг/мл, СОД с 170±3 до 207±7 Ед/мл, глутатион с 697±36 до 942±32 мкмоль/мл.

Заключение. Комбинированный метод терапии витилиго с включением симвастатина является эффективным и безопасным, приводит к стабилизации процесса, клиническому улучшению и выраженному эффекту терапии у 82% больных. Обладает также иммунокорригирующим действием и нормализует показатели оксидативного профиля.

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