文章摘要
修艳燕,黄鹤群,李 雪,宋乐彬,侯晓媛,冯 易,鲁 严.两种方法治疗难治性毛发变白白癜风疗效及影响因素评价[J].南京医科大学学报,2020,(5):713~719
两种方法治疗难治性毛发变白白癜风疗效及影响因素评价
Evaluating the efficiencies of two treatments for refractory vitiligo with leukotrichia and exploring the factors affecting the therapeutic effects
投稿时间:2019-12-13  
DOI:10.7655/NYDXBNS20200518
中文关键词: 难治性毛发变白白癜风  308 nm准分子光  CO2点阵激光  复色模式  影响因素分析
英文关键词: refractory vitiligo with leukotrichia  308 nm monochromatic excimer light  fractional CO2 laser  repigmentation pattern  root cause analysis
基金项目:国家自然科学基金(81872541,81171517,81602774);江苏省“333”工程项目(LGY2016009)
作者单位
修艳燕 南京医科大学第一附属医院皮肤科江苏 南京 210029 
黄鹤群 南京医科大学第一附属医院皮肤科江苏 南京 210029 
李 雪 南京医科大学附属妇产医院皮肤科江苏 南京 210004 
宋乐彬 南京医科大学第一附属医院皮肤科江苏 南京 210029 
侯晓媛 南京医科大学第一附属医院皮肤科江苏 南京 210029 
冯 易 南京医科大学第一附属医院皮肤科江苏 南京 210029 
鲁 严 南京医科大学第一附属医院皮肤科江苏 南京 210029 
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中文摘要:
      目的:比较改良方式的308 nm准分子光与CO2点阵激光分别联合卡泊三醇搽剂外用治疗难治性毛发变白白癜风疗效,并评估其疗效的影响因素。方法:收集2019年5月—2019年8月于南京医科大学第一附属医院皮肤科门诊就诊的常规药物或光疗3个月以上无效的毛发变白白癜风患者共60例,随机分为改良照光组(A组)和点阵激光组(B组),改良照光组以一块形状与白斑相同,边缘距白斑边缘内侧1 mm的不透光黑布紧贴于白斑表面,308 nm准分子光照射区域局限于白斑边缘,每周3次,疗程为36次,共3个月,点阵激光组每月行点阵激光1次,疗程为3次,共3个月,两组均联合卡泊三醇搽剂外用。疗程结束后评估两组疗效及复色模式,并采集患者基本信息,采用单因素和多因素Logistic回归分析方法进行疗效影响因素分析。结果:改良照光组总有效率和总显效率(89.5%,50.9%)均显著高于点阵激光组(67.6%,22.1%)(P<0.01)。改良照光组39片(68.4%)边缘复色,10片(17.8%)混合复色,6片(10.5%)毛囊复色,2片(3.5%)均一复色;点阵激光组49片(72.1%)边缘复色,9片(13.2%)毛囊复色,6片(8.8%)均一复色,4片(5.9%)混合复色。多因素Logistic回归分析显示,病程≤2年、复色无进展时间≤1年、无血清甲状腺抗体升高、白斑位于面颈部、非节段型白癜风是难治性毛发变白白癜风治疗显效的独立影响因素。结论:两种方法治疗难治性毛发变白白癜风均可在短期内起效,改良方式的308 nm准分子光照射联合卡泊三醇外用疗效更明显。边缘复色为主要复色模式。病程、复色无进展时间、血清甲状腺抗体是否升高、白斑部位和白癜风分型是影响难治性毛发变白白癜风疗效的重要因素。
英文摘要:
      Objective:This study aims to evaluate the efficiencies of modified 308 nm monochromatic excimer light(MEL)and fractional CO2 laser respectively combining with topical calcipotriol treatments for refractory vitiligo with leukotrichia,and to search for factors associated with the treatment response. Methods:A prospective research was performed in 60 patients of refractory vitiligo with leukotrichia treated in the Department of Dermatology,The First Affiliated Hospital of Nanjing Medical University from May 2019 to August 2019,they were divided into group A and group B according to the random number table. Group A was treated with modified 308?nm MEL,a black opaque cloth with the same shape as the lesion is closely attached to the lesion surface,and the edge of the cloth is 1mm from the inner side of the lesion edge,the light focuses on the edge of the lesion,three times a week,36 times a course,combined with topical calcipotriol. Group B was treated with fractional CO2 laser once a month,3 times a course,combined with topical calcipotriol. The treatment time of both groups lasts for 3 months. The clinical efficacy and repigmentation pattern of both groups were assessed. We also assessed the factors associated with the clinical efficacy. Results:After treatment,the effective rate and markedly effective rate of group A(89.5%,50.9%)were significantly higher than group B(67.6%,22.1%)(P < 0.01). In group A,39(68.4%)lesions showed marginal repigmentation,10(17.8%)lesions showed mixed repigmentation,6(10.5%)lesions showed perifollicular repigmentation,2(3.5%)lesions showed diffuse repigmentation. In group B,49(72.1%)lesions showed marginal repigmentation,9(13.2%)lesions showed perifollicular repigmentation,6(8.8%)lesions showed diffuse repigmentation,4(5.9%)lesions showed mixed repigmentation. Multivariable analysis showed the following to be independent factors with markedly effect:disease duration≤2 years,duration with no repigmentation≤1 year,without elevated serum thyroid antibody,face and neck site,and nonsegmental subtype. Conclusions:Both combinations of modified 308 nm MEL and topical calcipotriol,and fractional CO2 laser and topical calcipotriol in the treatment of refractory vitiligo with leukotrichia have good clinical effect. The combination of modified 308?nm MEL and topical calcipotriol showed better therapeutic effect than the combination of fractional CO2 laser and topical calcipotriol. Marginal repigmentation pattern occurred most frequently in refractory vitiligo with leukotrichia. Disease duration,duration with no repigmentation,serum thyroid antibody,lesion site and subtype were shown to be independent prognostic factors of markedly effect in patients of refractory vitiligo with leukotrichia.
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