【摘要】： 研究背景 白癜風(fēng)是一種常見(jiàn)的對(duì)于患者身心損害較大的色素脫失性疾病,外科方法治療穩(wěn)定期非活動(dòng)性白癜風(fēng)效果較好。然而,黑素細(xì)胞的移植并不能針對(duì)白癜風(fēng)的潛在病因,病情的反復(fù)可能導(dǎo)致移植失敗甚至發(fā)生同形反應(yīng)。所以對(duì)于表皮移植的長(zhǎng)期療效需要進(jìn)一步的探討。目前國(guó)內(nèi)外尚無(wú)五年以上相關(guān)遠(yuǎn)期隨訪研究,而遠(yuǎn)期隨訪面臨著病人依從性較差失訪率高的困難。電話隨訪正普遍應(yīng)用于流行病學(xué)評(píng)估、慢性病健康教育、常見(jiàn)病發(fā)病率研究等方面,調(diào)查表的詢(xún)問(wèn)設(shè)計(jì)恰當(dāng)可以取得與當(dāng)面訪問(wèn)相似效力的結(jié)果。 目的 通過(guò)電話隨訪評(píng)估負(fù)壓吸皰自體表皮移植法治療白癜風(fēng)遠(yuǎn)期療效及相關(guān)影響因素。 方法 電話訪問(wèn)表皮移植后5-9年患者,評(píng)估患者的色素恢復(fù)程度、匹配程度、主觀評(píng)價(jià)、是否有色素移行,并分析其與患者性別、年齡、病程、類(lèi)型、治療部位、有無(wú)疾病活動(dòng)和是否伴發(fā)供皮區(qū)同形反應(yīng)等因素的相關(guān)性,了解表皮移植的遠(yuǎn)期療效,以及發(fā)生色素復(fù)脫失的比例。 結(jié)果 隨訪患者225名,移植皮片2421片。男107例,女118例,平均年齡：(27.55±12.56)歲,平均病程：(5.84±5.87)年。節(jié)段型患者52例,局限型97例,散發(fā)型63例,泛發(fā)型1例,肢端型12例。平均色素恢復(fù)程度：(89.50±25.25)%,患者移植主觀評(píng)價(jià)平均得分：(3.45±1.34)分,移植區(qū)色素匹配度平均得分：(3.30±1.30)分,色素移行發(fā)生率26.77%。供皮區(qū)僅1例患者發(fā)生同形反應(yīng),皮膚色素沉著發(fā)生率12.89%。移植后白癜風(fēng)新發(fā)率14.22%,皮片色素減退發(fā)生率9.48%。 對(duì)可能影響療效的相關(guān)因素分析提示,不同隨訪年限患者移植皮片的色素恢復(fù)面積和皮片色素匹配度得分差異均無(wú)統(tǒng)計(jì)學(xué)意義。男性患者主觀評(píng)價(jià)高于女性患者,中老年(40歲)患者移植皮片色素恢復(fù)面積大于年輕患者,患者病程越長(zhǎng)療效越佳。節(jié)段型白癜風(fēng)療效最佳,肢端型白癜風(fēng)色素恢復(fù)程度、色素匹配度評(píng)分稍差。各移植部位色素恢復(fù)面積無(wú)明顯差異,但色素匹配度得分面頸部高、手足低。供皮區(qū)發(fā)生皮膚色素沉著的患者其移植區(qū)色素匹配度得分明顯低于供皮區(qū)未發(fā)生皮膚色素沉著的患者。移植后移植皮片發(fā)生色素減退患者白癜風(fēng)新發(fā)率明顯高于未發(fā)生色素減退患者。合并其他治療的患者色素減退、移植失敗發(fā)生率高于單行表皮移植治療患者,移植皮片色素移行率低。 結(jié)論 負(fù)壓吸皰自體表皮移植法治療白癜風(fēng)長(zhǎng)期隨訪,療效穩(wěn)定、持久。男性患者主觀評(píng)價(jià)高,中老年(40歲)患者移植皮片色素恢復(fù)面積大于年輕患者,患者病程越長(zhǎng)療效越佳。節(jié)段型白癜風(fēng)療效最佳,肢端型白癜風(fēng)色素恢復(fù)程度、色素匹配度評(píng)分稍差。不同移植部位色素恢復(fù)面積無(wú)明顯差異。供皮區(qū)色素沉著影響移植區(qū)色素匹配度。色素減退與疾病活動(dòng)密切相關(guān)。是否合并其他治療需要進(jìn)一步研究以得出結(jié)論。
[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 鹵12.56) years, mean course of disease: (5.84 鹵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 鹵25.25)%, the average score of subjective evaluation of transplantation was (3.45 鹵1.34), the average score of pigment matching was (3.30 鹵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.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類(lèi)號(hào)】：R758.41

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本文編號(hào)：2290760