中华皮肤科杂志 ›› 2009, Vol. 42 ›› Issue (1): 16-18.

• 论著 • 上一篇    下一篇

自体表皮移植治疗白癜风疗效评价及相关因素分析

金永红 许爱娥   

  1. 安徽医科大学附属杭州临床学院杭州三院 杭州市第三人民医院皮肤科
  • 收稿日期:2008-02-21 修回日期:2008-05-28 出版日期:2009-01-15 发布日期:2009-01-15
  • 通讯作者: 金永红 E-mail:jinyonghong06@126.com

Assessment of long-term efficacy of autologous epidermal grafting in vitiligo and its correlated factors

金永红 Jin Yong-Hong   

  • Received:2008-02-21 Revised:2008-05-28 Online:2009-01-15 Published:2009-01-15
  • Contact: 金永红 Jin Yong-Hong E-mail:jinyonghong06@126.com

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摘要：

目的 评估自体表皮移植治疗白癜风的长期疗效及其相关影响因素。方法 通过问卷调查、电话随访、临床复诊的方式，观察负压吸疱自体表皮移植治疗白癜风的长期疗效，并分析其与移植后时间的长短、是否联合照射窄波UVB、以及与患者性别、年龄、治疗部位和是否伴发供皮区同形反应的相关性。 结果 接受自体表皮移植资料完整的白癜风患者310例，病期稳定至少半年以上，男161例，女149例，平均年龄（26.69 ± 11.76）岁。局限型98例，节段型123例，散在型62例，泛发型27例。共移植皮片1266片，随访1 ~ 5年后发现，痊愈815片，显效167片，好转117片，无效167片，治愈率64.38％，总有效率86.81％。另外，发现移植处色素沉着过度76例，占24.52％；色素减退66例，占21.29％，供皮区色素沉着过度34例，占10.97％，移植部位复发30例，占9.677％；其他部位新发12例，占3.871％，供皮区发生同形反应25例，占8.064%。对可能影响疗效的相关因素分析显示，自体表皮移植治疗白癜风后2年内尚稳定，随着时间的延长，疗效稍降低；活动较少、容易固定的部位疗效较好，其中腿部和手臂的效果最好，手足部、胸背部、面颈部次之，腰腹部效果最差（P < 0.01）。术后窄波UVB照射可以促进皮肤色素生成，供皮区发生同形反应对移植后疗效有一定影响（P < 0.05），移植疗效与性别及年龄无关（P > 0.05）。结论 自体表皮移植治疗白癜风的长期疗效较好，移植部位是影响疗效的主要因素。

关键词: 白癜风;表皮移植;自体

Abstract:

Objective To evaluate the long-term outcome of autologous epidermal grafting in vitiligo and its correlated factors. Methods A 1-5 year follow-up of 310 patients with vitiligo, who had been treated by autologous epidermal grafting, was carried out by questionnaires, phone interview, and clinical revisit. The relevance was estimated between the efficacy of the treatment and several factors, including the time length from the grafting to the follow up, patients′ age and gender, location of lesions treated, Koebner phenomenon on the donor sites, and the combination therapy with narrow band-ultraviolet B （NB-UVB）. Results Of the 310 patients, 161 were males and 149 females with an average age of 26.69 ± 11.76 years; 98 had localized vitiligo, 123 segmental vitiligo, 62 scattered vitiligo, 27 generalized vitiligo. Totally, 24 recipient areas with 1266 sheets were evaluated. Among these sheets, 815 （64.38%） achieved complete repigmentation, 167 obvious repigmentation, 117 some repigmentation, 167 no repigmentation, with a curative rate of 64.38% and total effective rate of 86.81%. Hyperpigmentation occurred in the recipient area of 76 （24.52%） patients, and donor area of 34 patients （10.97%）, and hypopigmentation developed in the recipient area of 66 patients （21.29%）. Relapse developed in the recipient areas of 30 patients, and new lesions in 12 patients （3.871%）. Koebner phenomenon was noticed in the donor sites of 25 （8.064%） patients. The efficacy of autologous epidermal grafting was stable within two years after the therapy, but reduced with the time. Increased efficacy was observed in those sites with little mobililty and large fixity. For example, the best efficacy was observed in the legs and arms, followed by feet and hands, chest and back, face and neck, finally by waist and abdomen （P < 0.01）. NB-UVB exposure could improve the repigmentation. Koebner phenomenon in donor sites was associated with a reduced efficacy of epidermal grafting （P < 0.05）. Gender and age seemed unrelated to the efficacy. Conclusions Autologous epidermal grafting has a good long-term efficacy for the treatment of vitiligo, and transplanted location may be the most important factor affecting the efficacy.

Key words: Vitiligo;epidermal graft;autologous