血液的紫外线照射：“被时间遗忘的疗法”？
Ultraviolet Irradiation of Blood: "The Cure That Time Forgot"?
作者信息
Hamblin Michael R
机构信息
Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
Department of Dermatology, Harvard Medical School, Boston, MA, 02115, USA.
出版信息
Adv Exp Med Biol. 2017;996:295-309. doi: 10.1007/978-3-319-56017-5_25.
Ultraviolet blood irradiation (UBI) was extensively used in the 1940s and 1950s to treat many diseases including septicemia, pneumonia, tuberculosis, arthritis, asthma and even poliomyelitis. The early studies were carried out by several physicians in USA and published in the American Journal of Surgery. However with the development of antibiotics, UBI use declined and it has now been called "the cure that time forgot". Later studies were mostly performed by Russian workers and in other Eastern countries and the modern view in Western countries is that UBI remains highly controversial.This chapter discusses the potential of UBI as an alternative approach to current methods used to treat infections, as an immune-modulating therapy and as a method for normalizing blood parameters. No resistance of microorganisms to UV irradiation has been reported, and multi-antibiotic resistant strains are as susceptible as their wild-type counterparts. Low and mild doses of UV kill microorganisms by damaging the DNA, while any DNA damage in host cells can be rapidly repaired by DNA repair enzymes. However the use of UBI to treat septicemia cannot be solely due to UV-mediated killing of bacteria in the blood-stream, as only 5-7% of blood volume needs to be treated with UV to produce the optimum benefit. UBI may enhance the phagocytic capacity of various phagocytic cells (neutrophils and dendritic cells), inhibit lymphocytes, and oxidize blood lipids. The oxidative nature of UBI may have mechanisms in common with ozone therapy and other oxygen therapies. There may be some similarities to extracorporeal photopheresis (ECP) using psoralens and UVA irradiation. However there are differences between UBI and ECP in that UBI tends to stimulate the immune system, while ECP tends to be immunosuppressive. With the recent emergence of bacteria that are resistant to all known antibiotics, UBI should be more investigated as an alternative approach to infections, and as an immune-modulating therapy.
紫外线血液照射（UBI）在20世纪40年代和50年代被广泛用于治疗多种疾病，包括败血症、肺炎、肺结核、关节炎、哮喘甚至小儿麻痹症。早期研究由美国的几位医生进行，并发表在美国《外科杂志》上。然而，随着抗生素的发展，UBI的使用逐渐减少，现在它被称为“被时代遗忘的疗法”。后来的研究大多由俄罗斯和其他东欧国家的研究人员进行，西方国家的现代观点认为UBI仍然存在很大争议。本章讨论了UBI作为治疗感染的现有方法的替代方法、作为一种免疫调节疗法以及作为一种使血液参数正常化的方法的潜力。尚未有微生物对紫外线照射产生抗性的报道，多重耐药菌株与其野生型对应菌株一样敏感。低剂量和温和剂量的紫外线通过破坏DNA来杀死微生物，而宿主细胞中的任何DNA损伤都可以被DNA修复酶迅速修复。然而，使用UBI治疗败血症不能仅仅归因于紫外线对血流中细菌的杀伤作用，因为仅需对5-7%的血容量进行紫外线处理就能产生最佳效果。UBI可能会增强各种吞噬细胞（中性粒细胞和树突状细胞）的吞噬能力，抑制淋巴细胞，并氧化血脂。UBI的氧化性质可能与臭氧疗法和其他氧疗法有共同的机制。它可能与使用补骨脂素和紫外线A照射的体外光化学疗法（ECP）有一些相似之处。然而，UBI和ECP之间存在差异，即UBI倾向于刺激免疫系统，而ECP倾向于免疫抑制。随着最近出现对所有已知抗生素都有抗性的细菌，UBI作为治疗感染的替代方法和免疫调节疗法应得到更多研究。
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