关键词: 白癜风, 糖皮质激素类, 治疗结果, 光疗法, 进展期白癜风, 复方倍他米松注射液

Abstract: 【Abstract】 Objective To investigate the disease control rate and its influencing factors in patients with progressive non-segmental vitiligo after combined treatment with systemic compound betamethasone injection （CBI）. Methods A retrospective analysis was conducted on the patients with progressive non-segmental vitiligo, who visited and were treated with CBI in the Department of Dermatology, Hangzhou Third People′s Hospital from October 2022 to April 2023. The disease control rate was analyzed after 3-month treatment. Effects of clinical factors such as disease onset characteristics, duration, disease condition and treatment methods on the disease control rate were analyzed. Chi-square test was used for comparisons of enumeration data between groups, and logistic regression analysis was conducted to analyze factors influencing the efficacy. Results A total of 145 progressive non-segmental vitiligo patients treated with CBI were collected, including 56 males and 89 females, aged 14 - 67 （35.43 ± 11.54） years. Among the 18 patients having received an intramuscular injection of CBI, 10（55.6%）obtained stable condition; among the 105 having received 2 injections of CBI, 60 （59.0%） obtained stable condition; among the 22 having received 3 or 4 injections of CBI, 12（54.5%）obtained stable condition. The overall disease control rate after treatment was 57.9% （84 cases）. The disease control rate was significantly higher in the patients with the lesional area < 1% body surface area （BSA） （42/47, 89.4%） than in those with the lesional area ≥ 1% BSA （42/98, 42.9%; P < 0.001）, significantly higher in the patients with disease duration ≤ 2 years （32/41, 78.0%） than in those with disease duration > 2 years （52/104, 50.0%; P < 0.05）, and significantly higher in the patients treated with CBI combined with phototherapy （33/44, 75.0%） than in those treated with CBI alone （21/44, 47.7%; χ2 = 6.90, P = 0.009）, but significantly lower in the patients with special clinical markers （Koebner phenomenon, trichrome vitiligo, confetti-like depigmentation, inflammatory vitiligo, etc., 4/21, 19.9%） than in those without special clinical markers （80/124, 64.5%, P < 0.001）. Among the patients with the lesional area ≥ 1% BSA and receiving 2 injections of CBI, the disease control rate was also significantly higher in the patients treated with CBI combined with phototherapy （21/36, 58.3%） than in those treated with CBI alone （12/37, 32.4%; χ2 = 4.94, P = 0.026）. There was no significant difference in the disease control rate after the treatment between the patients with first-onset and reccurrent vitiligo, between those with and without predisposing factors, between those with and without family history, among those with different vitiligo disease activity scores, among those with different number of injections, as well as among those with different treatment intervals （all P > 0.05）. Multivariate logistic regression analysis showed that the lesional area （OR = 8.11, 95% CI: 2.74 - 24.04）, disease duration （OR = 0.26, 95% CI: 0.07 - 0.99）, having or not having special clinical markers （OR = 6.37, 95% CI: 1.72 - 23.57）, and whether or not receiving combined phototherapy （OR = 0.34, 95% CI: 0.15 - 0.77） were factors influencing the efficacy （all P < 0.05）. Conclusion CBI may be suitable for the treatment of mild to moderate progressive vitiligo, especially for patients with lesional area < 1% BSA, while not for those with lesional area > 5% BSA, and combining phototherapy may improve the control rate of progressive vitiligo.

Key words: Vitiligo, Glucocorticoids, Treatment outcome, Phototherapy, Progressive vitiligo, Compound betamethasone injection