窄谱中波紫外线围白斑照射治疗难治性白癜风的临床疗效观察  

Clinical efficacy of narrow-band ultraviolet B irradiation around vitiliginous lesions in the treatment of refractory vitiligo

作　　者：陈林 修艳燕 周炳荣[1] 侯晓媛 王浩洋 曹雪琛 鲁严[1] Chen Lin;Xiu Yanyan;Zhou Bingrong;Hou Xiaoyuan;Wang Haoyang;Cao Xuechen;Lu Yan(Department of Dermatology,The First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院,江苏省人民医院皮肤科,210029

出　　处：《中华皮肤科杂志》2021年第10期851-855,共5页Chinese Journal of Dermatology

基　　金：国家自然科学基金(81872541,81171517)。

摘　　要：目的探讨窄谱中波紫外线围白斑照射治疗难治性白癜风的临床疗效。方法回顾2019年6月至2020年11月南京医科大学第一附属医院皮肤科治疗的126例难治性白癜风,分别采用遮盖白斑、窄谱中波紫外线照射围白斑区域皮肤和常规照射白斑治疗,每周2次,持续3个月。治疗结束后评估2组的疗效。运用倾向性评分匹配分析,按1:1匹配。采用单因素和多因素Logistic回归分析、分层分析围白斑照射法对于难治性白癜风的临床疗效。结果采用围白斑照射组皮损420处,常规照射组257处,倾向性评分匹配后每组各190处,匹配前后,围白斑照射组有效率(71.9%,67.9%)均高于常规照射组(31.9%、30.0%,均P<0.05)。倾向性评分匹配后单因素Logistic回归分析显示,围白斑照射与常规照射对疗效的影晌差异有统计学意义(OR=4.9,95%CI:3.2,7.6,P<0.001);多因素分析显示,围白斑照射与常规照射对疗效的影响差异亦有统计学意义(OR=12.0,95%CI:6.5,22.3,P<0.001)。对不同毛发类型与照射方法对白斑疗效的影响进行分层分析,匹配前,毛白白斑采用常规照射187处,围白斑照射246处,毛黑白斑采用常规照射70处,围白斑照射174处;匹配后,毛白白斑两照射组各140处,毛黑白斑各50处。对于毛白白斑,匹配前后围白斑照射组的有效率(77.6%、72.8%)均好于常规照射组(19.3%、20.7%,P<0.01)。对于毛黑白斑,匹配后两组疗效差异无统计学意义(P=0.908)。结论围白斑窄谱中波紫外线对于治疗难治性白癜风尤其是白斑处毛发变白的皮损疗效优于一般照射方法。Objective To investigate clinical efficacy of narrow-band ultraviolet B(NB-UVB)irradiation around vitiliginous lesions in the treatment of refractory vitiligo.Methods A total of 126 patients with refractory vitiligo were retrospectively collected from Department of Dermatology,the First Affiliated Hospital of Nanjing Medical University from June 2019 to November 2020.The patients were treated with NB-UVB irradiation around vitiliginous lesions after partial covering(perilesional irradiation group),or conventional NB-UVB irradiation(conventional irradiation group),twice a week for 3 consecutive months.After the treatment,the efficacy was evaluated.By using the propensity score method,the lesions in the 2 groups were matched at a ratio of 1:1.Univariate and multivariate logistic regression analyses and stratified analysis were used to analyze the clinical efficacy of NB-UVB irradiation around vitiliginous lesions in the treatment of refractory vitiligo.Results Totally,there were 420 skin lesions in the perilesional irradiation group and 257 in the conventional irradiation group,and 190 lesions were enrolled into each group by propensity-score matching.Before and after the matching,the response rates were both significantly higher in the perilesional irradiation group(71.9%,67.9%,respectively)than in the conventional irradiation group(31.9%,30.0%,respectively,both P<0.05).After the propensity-score matching,both univariate and multivariate logistic regression analyses showed significant differences in the efficacy between the perilesional irradiation group and conventional irradiation group(OR=4.9,95%CI:3.2,7.6,P<0.001;OR=12.0,95%CI:6.5,22.3.P<0.001,respeetively).Viliginous lesions were elassified according to hair types and iradiation methods:before the matching.there were 187 vitiliginous lesions with white hairs treated with the conventional irradiation and 246 treated with the perilesional irradiation,and there were 70 vitiliginous lesions with black hairs treated with the conventional rradiation.and 174 treated

关 键 词：白癜风 紫外线疗法 围白斑照射法 

分 类 号：R758.41[医药卫生—皮肤病学与性病学]