黑素细胞单独移植与黑素细胞和角质形成细胞共培养混合移植治疗节段型白癜风临床疗效比较

Clinical analysis and comparison of transplantation of culture autologous melanocytes and melanocytes-keratinocytes in the treatment of segmental vitiligo

目的:观察自体培养黑素细胞(MC)单独移植与MC和角质形成细胞(KC)共培养混合移植治疗节段型白癜风的临床疗效。方法:选择20例稳定期节段型白癜风患者,用负压吸疱法在白癜风患者正常皮肤区吸疱取皮,在相应的培养基中分别培养MC和KC,体外建立MC和KC共培养模型。最后将MC悬液、MC和KC混合悬液分别用于移植治疗白癜风患者的皮损区,观察移植后色素生成效果,并进行临床疗效分析比较。结果:20例患者32个皮损区接受了移植治疗,移植1个月后皮损区出现明显的色素产生,4~5个月后所有皮损区均有色素再生,6~8个月后色素恢复稳定,颜色与周围正常皮肤接近,未见瘢痕和其他不良反应。MC单独移植治疗16个皮损区,有效率68.75%,痊愈率25%。MC和KC共培养混合移植治疗16个皮损区,有效率81.25%,痊愈率56.52%。两组间有效率与痊愈率比较差异均有统计学意义(P<0.05)。结论:采用自体细胞培养移植方法治疗稳定期节段型白癜风疗效肯定,有治疗面积大、成功率高、用少量供皮区即可治疗大面积皮损等优点。MC和KC共培养混合移植治疗效果可能优于MC单独移植。

Objective： To observe the therapeutic effect of transplantation of cultured autologous melanocytes（MC） and melanocytes-keratinocytes（MC-KC） in segmental vitiligo. Methods： 20 patients with stable segmental vitiligo were selected. Blisters were in- duced in vitiligo patients by negative pressure suction. MC and KC were cultured respectively in corresponding medium, and then the cocuhure model of direct was established in vitro. The MC suspension and MC-KC suspension were used in the treat- ment of vitiligo patients with depigmentations areas. Pepigmentation effect was observed continuously in the transplanted areas. Results： MC and KC could be proliferated in medium when they were cultured separately. The two kinds of cells proliferated rapidly when they cocuhured in a certain proportion. And then MC suspension and MC-KC suspension were acquired success- fully. Totally, 20 vitiligo patients with 32 depigmented areas were treated with transplantation of autologous KC or MC-KC. Af- ter one month, partial repigmentation was observed in the transplanted areas. After 4-5 months, repigmentation was observed in all the transplanted areas. After 6-8 mouths, the pigmentation leveled off, and these areas were similar in color to the normal skin around. No scarring or other side effects were observed. The effective rate and cure rate were 68.75% and 25% respectively in the group of MC transplantation, 81.25% and 56.52% respectively in the group of MC-KC transplantation. The two groups showed statistical difference in the effective rate and cure rate （P〈0.05）. And the effective rates of the two groups were 75% and 43.75% respectively. Conclusion： Transplantation of cultured autologous cells is an effective and safe modality in the treatment of stable segmental vitiligo, with the advantage of treating large depigmented area with small size of donor epidermis. MC-KC mixed transplantation may be superior to the treatment of simple MC transplantation.