白癜风患者窄谱中波紫外线治疗效果与光疗反应的关系及相关因素分析

Association between efficacy of and response to narrow-band ultraviolet B phototherapy as well as factors related to phototherapy response in patients with vitiligo

目的评估白癜风患者窄谱中波紫外线(NB-UVB)治疗效果与光疗反应的关系,并探讨光疗反应的影响因素。方法收集2017年1月至2018年3月在浙江中医药大学附属杭州第三医院确诊并在光疗中心接受NB-UVB光疗的104例白癜风患者,其中男55例,女49例,平均年龄32.06岁(4~64岁);病程2个月至27年,平均8.15年。记录患者初始复色、出现平台期所需光疗次数和有效光疗次数。采用秩和检验评估不同疗效的患者上述指标的差异,多元线性回归分析寻找出现平台期所需光疗次数及有效复色光疗次数的影响因素。结果随访104例患者,其中2例色素脱失斑完全复色,1例对光疗完全无反应,52例复色面积≥50%(效优组),49例<50%(效差组)。排除完全复色患者2例和治疗无反应患者1例,共101例患者纳入分析。效优组初始复色所需光疗次数[M(P25,P75),8(7,10)]少于效差组[10(8,13),Z=3.125,P=0.002],达到平台期所需光疗次数[41(29,60)]及有效复色光疗次数[32(18,51)]均高于效差组[分别为35(26,44)和24(8,36),Z值分别为-3.375、-4.407,P<0.001]。达到平台期所需光疗总次数与皮损面积(β=0.360,t=2.698,P=0.008)、病程(β=0.215,t=2.325,P=0.022)呈正相关,与白癜风疾病活动度(VIDA)评分(β=-2.665,t=-3.969,P<0.001)呈负相关;有效复色光疗次数与皮损面积(β=0.358,t=2.582,P=0.011)、病程(β=0.216,t=2.276,P=0.025)呈正相关,与白癜风VIDA评分(β=-2.669,t=-3.935,P<0.001)和初始复色起效次数(β=-1.011,t=-4.508,P<0.001)均呈负相关。结论白癜风患者接受NB-UVB治疗时初始复色光疗次数越少,复色期间有效光疗次数越多,光疗效果越好;皮损面积、病程及分期可为光疗患者预测到达平台期所需光疗次数提供一定依据。

Objective To evaluate the association between clinical efficacy of and response to narrow-band ultraviolet B(NB-UVB)phototherapy in patients with confirmed vitiligo,and to identify factors influencing phototherapy response.Methods From January 2017 to March 2018,a total of 104 patients with vitiligo,who received NB-UVB phototherapy at the Department of Dermatology,Hangzhou Third Hospital,Zhejiang University of Traditional Chinese Medicine,were enrolled into this study.Among them,there were 55 males and 49 females,with an average age of 32.06 years(range:4-64 years).Their course of disease ranged from 2 months to 27 years,and the average course of disease was 8.15 years.The phototherapy sessions required to achieve initial repigmentation and to enter the plateau phase during which repigmentation ceased to increase with treatment sessions(plateau photothereapy sessions),as well as effective phototherapy sessions(the difference between the phototherapy sessions required to achieve initial repigmentation and those to enter the plateau phase)were recorded.Rank sum test was used to analyze the difference in the above phototherapy sessions between patients with different response,and multiple linear regression analysis to identify factors influencing plateau photothereapy sessions and effective phototherapy sessions.Results All the 104 patients were followed up.Among them,2 patients achieved complete repigmentation,1 showed no response to the phototherapy,and the remaining 101 patients were enrolled into the analysis.Among the 101 patients,52 achieved≥50% repigmentation(high efficacy group),and 49 achieved<50% repigmentation(low efficacy group).Compared with the low efficacy group,the high efficacy group showed significantly less phototherapy sessions required to achieve initial repigmentation(M [P25,P75],8[7,10] vs.10[8,13],Z=3.125,P=0.002),but significantly more plateau phototherapy sessions(41[29,60] vs.35[26,44],Z=-3.375,P<0.001)and effective phototherapy sessions(32[18,51] vs.24[8,36],Z=-4.407,P<0.001).Multiple linear regression analysis showed that the total number of plateau phototherapy sessions was positively correlated with vitiligo area(β=0.360,t=2.698,P=0.008)and duration of disease(β=0.215,t=2.325,P=0.022),but negatively correlated with vitiligo disease activity score(VIDA)(β=-2.665,t=3.969,P<0.001).Moreover,the number of effective phototherapy sessions was positively correlated with vitiligo area(β=0.358,t=2.582,P=0.011)and duration of disease(β=0.216,t=2.276,P=0.025),but negatively correlated with VIDA(β=-2.669,t=-3.935,P<0.001)and phototherapy sessions required to achieve initial repigmentation(β=-1.011,t=-4.508,P<0.001).Conclusions During the treatment with NB-UVB,the less the number of phototherapy sessions required to achieve initial repigmentation is,the more the number of effective phototherapy sessions is,and the better the efficacy of NB-UVB phototherapy is.Vitiligo area,duration of disease and clinical staging may provide the basis for predicting phototherapy sessions required to enter the plateau phase.