白癜风黑素细胞移植供皮区同形反应严重程度与疗效的关系

Relationship between the severity of isomorphic response at the donor site and the therapeutic effect of cultured melanocyte transplantation in patients with vitiligo

目的 探讨白癜风黑素细胞移植供皮区同形反应严重程度在评估移植疗效中的作用。方法 2008年5月至2016年8月，在杭州市第三人民医院皮肤科接受黑素细胞（培养或混悬）移植治疗、供皮区出现同形反应的172例白癜风患者，依据供皮区同形反应面积分为两组：部分同形反应组（同形反应面积小于吸疱面积）和完全同形反应组（同形反应面积等于吸疱面积），分析两组的移植疗效及与同形反应相关性。结果 172例供皮区出现同形反应中，部分同形反应83例，完全同形反应89例。部分同形反应组痊愈21例（25.3%），显效17例（20.5%），有效率45.8%，有效率高于完全同形反应组［痊愈4例（4.5%），有效11例（12.4%），有效率16.9%，χ2 = 31.581，P 〈 0.001］。部分同形反应组白癜风稳定时间（18.5 ± 15.3）个月，高于完全同形反应组［（10.2 ± 7.3）个月］，t = 4.581，P 〈 0.001。相关分析显示，白癜风稳定时间（6 ~ 11个月、12 ~ 23个月、24 ~ 35个月、36 ~ 47个月、 ≥ 48个月）与同形反应严重程度（部分或完全）呈负相关（rs = -0.322，P 〈 0.001），与复色率呈正相关（r = 0.675，P 〈 0.001）。结论 白癜风稳定时间是影响供皮区有同形反应患者黑素细胞移植疗效的重要因素，同形反应严重程度提示稳定时间长短，可预测移植疗效。

Objective To investigate the value of the severity of isomorphic response at the donor site in evaluation of the therapeutic effect of cultured melanocyte transplantation. Methods A total of 172 vitiligo patients, who received cultured melanocyte transplantation or non-cultured epidermal suspension transplantation at the Department of Dermatology of Hangzhou Third Hospital from May 2008 to August 2016 and developed isomorphic response at the donor site, were enrolled into this study. According to the area of isomorphic response, these patients were divided into 2 groups： incomplete isomorphic response group whose area of isomorphic response was less than the suction area, and complete isomorphic response group whose area of isomorphic response was equal to the suction area. The correlation between therapeutic effects of melanocyte transplantation and isomorphic response was analyzed. Results Of the 172 patients, 83 had incomplete isomorphic response, and 89 had complete isomorphic response at the donor site. In the incomplete isomorphic response group, 21 （25.3%） patients were cured, and 17 （20.5%） were markedly improved, while 4 （4.5%） patients were cured, and 11 （12.4%） were improved in the complete isomorphic response group. Additionally, the response rate was significantly higher in the incomplete isomorphic response group than in the complete isomorphic response group （45.8% vs. 16.9%, χ2 = 31.581, P 〈 0.001）. Furthermore, the duration of stable phase was also significantly longer in the incomplete isomorphic response group than in the complete isomorphic response group （18.5 ± 15.3 months vs. 10.2 ± 7.3 months, t = 4.581, P 〈 0.001）. Correlation analysis showed that the duration of stable phase, which was classified into 5 grades including 6 - 11 months, 12 - 23 months, 24 - 35 months, 36 - 47 months and ≥ 48 months, was negatively correlated with the severity （incomplete or complete） of isomorphic response （rs = -0.322, P 〈 0.001）, but positively correlated with repigmentation rates of the skin lesions （rs = 0.675, P 〈 0.001）. Conclusion The length of duration of stable phase is an important factor affecting the therapeutic effect of melanocyte transplantation in vitiligo patients with isomorphic response at the donor site, and the severity of isomorphic response can indicate the length of duration of stable phase and predict the therapeutic effect of melanocyte transplantation.