负压吸疱自体表皮移植法治疗白癜风远期疗效的随访和评价
发布时间：2018-10-24 07:43
【摘要】： 研究背景 白癜风是一种常见的对于患者身心损害较大的色素脱失性疾病,外科方法治疗稳定期非活动性白癜风效果较好。然而,黑素细胞的移植并不能针对白癜风的潜在病因,病情的反复可能导致移植失败甚至发生同形反应。所以对于表皮移植的长期疗效需要进一步的探讨。目前国内外尚无五年以上相关远期随访研究,而远期随访面临着病人依从性较差失访率高的困难。电话随访正普遍应用于流行病学评估、慢性病健康教育、常见病发病率研究等方面,调查表的询问设计恰当可以取得与当面访问相似效力的结果。 目的 通过电话随访评估负压吸疱自体表皮移植法治疗白癜风远期疗效及相关影响因素。 方法 电话访问表皮移植后5-9年患者,评估患者的色素恢复程度、匹配程度、主观评价、是否有色素移行,并分析其与患者性别、年龄、病程、类型、治疗部位、有无疾病活动和是否伴发供皮区同形反应等因素的相关性,了解表皮移植的远期疗效,以及发生色素复脱失的比例。 结果 随访患者225名,移植皮片2421片。男107例,女118例,平均年龄：(27.55±12.56)岁,平均病程：(5.84±5.87)年。节段型患者52例,局限型97例,散发型63例,泛发型1例,肢端型12例。平均色素恢复程度：(89.50±25.25)%,患者移植主观评价平均得分：(3.45±1.34)分,移植区色素匹配度平均得分：(3.30±1.30)分,色素移行发生率26.77%。供皮区仅1例患者发生同形反应,皮肤色素沉着发生率12.89%。移植后白癜风新发率14.22%,皮片色素减退发生率9.48%。 对可能影响疗效的相关因素分析提示,不同随访年限患者移植皮片的色素恢复面积和皮片色素匹配度得分差异均无统计学意义。男性患者主观评价高于女性患者,中老年(40岁)患者移植皮片色素恢复面积大于年轻患者,患者病程越长疗效越佳。节段型白癜风疗效最佳,肢端型白癜风色素恢复程度、色素匹配度评分稍差。各移植部位色素恢复面积无明显差异,但色素匹配度得分面颈部高、手足低。供皮区发生皮肤色素沉着的患者其移植区色素匹配度得分明显低于供皮区未发生皮肤色素沉着的患者。移植后移植皮片发生色素减退患者白癜风新发率明显高于未发生色素减退患者。合并其他治疗的患者色素减退、移植失败发生率高于单行表皮移植治疗患者,移植皮片色素移行率低。 结论 负压吸疱自体表皮移植法治疗白癜风长期随访,疗效稳定、持久。男性患者主观评价高,中老年(40岁)患者移植皮片色素恢复面积大于年轻患者,患者病程越长疗效越佳。节段型白癜风疗效最佳,肢端型白癜风色素恢复程度、色素匹配度评分稍差。不同移植部位色素恢复面积无明显差异。供皮区色素沉着影响移植区色素匹配度。色素减退与疾病活动密切相关。是否合并其他治疗需要进一步研究以得出结论。
[Abstract]:Background Vitiligo is a common disorder with large physical and mental damage. Surgical treatment of inactive vitiligo in stable stage is effective. However, melanocyte transplantation can not be targeted at the potential cause of vitiligo, the recurrence of the disease may lead to transplant failure or even homotypic reaction. Therefore, the long-term effect of epidermal transplantation needs further discussion. At present, there are no related long-term follow-up studies at home and abroad, and long term follow-up is faced with the difficulty of poor compliance and high failure rate. Telephone follow-up is widely used in epidemiological assessment, health education of chronic diseases, incidence of common diseases and so on. The results of questionnaire design are similar to those of in-person interviews. Objective to evaluate the long-term efficacy and related factors of autogenous epidermis transplantation in the treatment of vitiligo by telephone follow-up. Methods the patients were interviewed by telephone for 5-9 years after epidermis transplantation to assess the degree of pigment recovery, matching degree, subjective evaluation, and whether there was pigmentation, and to analyze their relationship with gender, age, course of disease, type, treatment site. The correlation between disease activity and isomorphic reaction of donor skin area, the long-term effect of epidermis transplantation, and the proportion of pigmentation loss were investigated. Results A total of 225 patients were followed up and 2421 skin grafts were grafted. 107 males and 118 females, mean age: (27.55 卤12.56) years, mean course of disease: (5.84 卤5.87) years. There were 52 cases of segmental type, 97 cases of localized type, 63 cases of sporadic type, 1 case of extensive type and 12 cases of extremity type. The average degree of pigment recovery was (89.50 卤25.25)%, the average score of subjective evaluation of transplantation was (3.45 卤1.34), the average score of pigment matching was (3.30 卤1.30), the incidence of pigmentation migration was 26.77. Only one patient in the donor area had the same reaction, and the incidence of pigmentation was 12.89%. The new incidence rate of vitiligo after transplantation was 14.22 and the incidence of hypopigmentation of skin grafts was 9.48. The analysis of the related factors which may affect the curative effect indicated that there was no significant difference in the pigment recovery area and the pigment matching degree of the skin graft in patients with different follow-up years. The subjective evaluation of male patients was higher than that of female patients, and the recovery area of skin graft pigment in middle-aged and aged patients (40 years old) was larger than that in young patients, and the longer the course of disease was, the better the curative effect was. The effect of segmental vitiligo was the best, and the pigment recovery degree and pigment matching degree of extremity type vitiligo were slightly poor. There was no significant difference in the pigment recovery area among the grafts, but the pigment matching score was higher in the face and neck, and lower in the hands and feet. The matching score of skin pigmentation in the donor area was significantly lower than that in the donor area. The new incidence of vitiligo was significantly higher in patients with hypothyroidism after transplantation than in patients without hypothyroidism. The incidence of graft failure in patients with other treatments was higher than that in patients with single epidermis transplantation, and the rate of pigmentation in skin grafts was lower. Conclusion the treatment of vitiligo by autoepidermal transplantation with vacuum suction is stable and lasting. Male patients had high subjective evaluation. The recovery area of skin graft pigment was larger in middle-aged and old patients (40 years old) than in young patients, and the longer the course of disease was, the better the curative effect was. The effect of segmental vitiligo was the best, and the pigment recovery degree and pigment matching degree of extremity type vitiligo were slightly poor. There was no significant difference in pigment recovery area among different transplant sites. Pigmentation in the donor area affected the matching degree of pigments in the graft area. Hypopigmentation is closely related to disease activity. Whether or not to combine other treatments requires further study in order to reach a conclusion.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R758.41
本文编号：2290760
[Abstract]:Background Vitiligo is a common disorder with large physical and mental damage. Surgical treatment of inactive vitiligo in stable stage is effective. However, melanocyte transplantation can not be targeted at the potential cause of vitiligo, the recurrence of the disease may lead to transplant failure or even homotypic reaction. Therefore, the long-term effect of epidermal transplantation needs further discussion. At present, there are no related long-term follow-up studies at home and abroad, and long term follow-up is faced with the difficulty of poor compliance and high failure rate. Telephone follow-up is widely used in epidemiological assessment, health education of chronic diseases, incidence of common diseases and so on. The results of questionnaire design are similar to those of in-person interviews. Objective to evaluate the long-term efficacy and related factors of autogenous epidermis transplantation in the treatment of vitiligo by telephone follow-up. Methods the patients were interviewed by telephone for 5-9 years after epidermis transplantation to assess the degree of pigment recovery, matching degree, subjective evaluation, and whether there was pigmentation, and to analyze their relationship with gender, age, course of disease, type, treatment site. The correlation between disease activity and isomorphic reaction of donor skin area, the long-term effect of epidermis transplantation, and the proportion of pigmentation loss were investigated. Results A total of 225 patients were followed up and 2421 skin grafts were grafted. 107 males and 118 females, mean age: (27.55 卤12.56) years, mean course of disease: (5.84 卤5.87) years. There were 52 cases of segmental type, 97 cases of localized type, 63 cases of sporadic type, 1 case of extensive type and 12 cases of extremity type. The average degree of pigment recovery was (89.50 卤25.25)%, the average score of subjective evaluation of transplantation was (3.45 卤1.34), the average score of pigment matching was (3.30 卤1.30), the incidence of pigmentation migration was 26.77. Only one patient in the donor area had the same reaction, and the incidence of pigmentation was 12.89%. The new incidence rate of vitiligo after transplantation was 14.22 and the incidence of hypopigmentation of skin grafts was 9.48. The analysis of the related factors which may affect the curative effect indicated that there was no significant difference in the pigment recovery area and the pigment matching degree of the skin graft in patients with different follow-up years. The subjective evaluation of male patients was higher than that of female patients, and the recovery area of skin graft pigment in middle-aged and aged patients (40 years old) was larger than that in young patients, and the longer the course of disease was, the better the curative effect was. The effect of segmental vitiligo was the best, and the pigment recovery degree and pigment matching degree of extremity type vitiligo were slightly poor. There was no significant difference in the pigment recovery area among the grafts, but the pigment matching score was higher in the face and neck, and lower in the hands and feet. The matching score of skin pigmentation in the donor area was significantly lower than that in the donor area. The new incidence of vitiligo was significantly higher in patients with hypothyroidism after transplantation than in patients without hypothyroidism. The incidence of graft failure in patients with other treatments was higher than that in patients with single epidermis transplantation, and the rate of pigmentation in skin grafts was lower. Conclusion the treatment of vitiligo by autoepidermal transplantation with vacuum suction is stable and lasting. Male patients had high subjective evaluation. The recovery area of skin graft pigment was larger in middle-aged and old patients (40 years old) than in young patients, and the longer the course of disease was, the better the curative effect was. The effect of segmental vitiligo was the best, and the pigment recovery degree and pigment matching degree of extremity type vitiligo were slightly poor. There was no significant difference in pigment recovery area among different transplant sites. Pigmentation in the donor area affected the matching degree of pigments in the graft area. Hypopigmentation is closely related to disease activity. Whether or not to combine other treatments requires further study in order to reach a conclusion.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R758.41
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