进展期非节段型白癜风患者对系统糖皮质激素治疗反应的相关影响因素研究  

Investigation of clinical factors influencing the response to systemic glucocorticoid treatment in patients with progressive non-segmental vitiligo

作　　者：宣依洁 杨奕雯 王琛 徐中奕 项蕾红 张成锋 Xuan Yijie;Yang Yiwen;Wang Chen;Xu Zhongyi;Xiang Leihong;Zhang Chengfeng(Department of Dermatology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院皮肤科,上海200040

出　　处：《中华皮肤科杂志》2024年第1期17-22,共6页Chinese Journal of Dermatology

基　　金：国家自然科学基金(82173421);上海市自然科学基金(23ZR1408600);上海市卫健委科研项目(20234Z0014)。

摘　　要：目的比较系统糖皮质激素治疗敏感与治疗抵抗的进展期非节段型白癜风患者的临床资料及外周血CXC趋化因子配体(CXCL)9及CXCL10水平,寻找影响系统糖皮质激素治疗敏感性的临床因素.方法2021年5月至2023年5月于复旦大学附属华山医院建立系统糖皮质激素治疗的进展期非节段型白癜风患者队列,前瞻性收集队列中所有患者的临床资料和外周血样本,给予入组患者标准治疗:复方倍他米松注射液1ml肌内注射每月1次.治疗3个月后,观察患者皮损改善情况,同时采用白癜风面积及严重程度(VASI)评分和白癜风欧洲工作组评估工具(VETFa)评估疗效.VASI评分变化≥0且VETFa进展期评分≤0分为激素敏感组(即病情稳定或好转),而VASI评分变化<0且VETFa进展期评分为1分则为激素抵抗组.分析皮损部位、特殊临床标记(三色征、碎屑样改变、同形反应)、既往用药史、白癜风家族史等与系统糖皮质激素治疗应答的关联.基线及治疗3个月后,采集患者外周血样本,采用酶联免疫吸附试验检测血浆中CXCL9及CXCL10含量.统计分析采用X^(2)检验、Fisher确切概率法、二分类logistic回归、Mann-Whitney U检验和Wilcoxon配对符号秩和检验.结果共入组142例,127例完成3个月的治疗随访,其中男77例,女50例,就诊年龄18~65(36.6±11.4)岁,病程2个月至58(13.5±10.7)年;有白癜风家族史25例(19.7%);治疗前皮损面积(BSA)1%~70%(11.5%±12.7%),VASI评分1%~70%(10.8%±11.6%).多因素logistic回归分析显示,无特殊临床标记[比值比(OR)=6.900,95%可信区间(CI):1.228,38.757,P=0.028]、单一特殊临床标记(OR=2.579,95%CI:1.012,6.574,P=0.047)、外用糖皮质激素治疗史(OR=2.643,95%CI:1.019,6.850,P=0.041)、无白癜风家族史(OR=5.090,95%CI:1.070,24.215,P=0.030)、发病部位为四肢近端(OR=3.767,95%CI:1.315,10.793,P=0.037)是白癜风患者对糖皮质激素治疗抵抗的危险因素.治疗3个月后,激素敏感组CXCL10水平显著低于Objective To compare the clinical data and peripheral blood levels of CXC chemokine ligand(CXCL)9 and CXCL10 between patients with progressive non-segmental vitiligo who were sensitive to systemic glucocorticoid treatment and those who were resistant,and to clarify key clinical factors influencing the sensitivity to systemic glucocorticoid treatment.Methods From May 2021 to May 2023,a cohort of patients with progressive non-segmental vitiligo receiving systemic glucocorticoid treatment was established in Huashan Hospital,Fudan University.Clinical data and peripheral blood samples were prospectively collected from all enrolled patients.Standard treatment,i.e.,intramuscular injections of 1 ml of compound betamethasone once a month,was administered.After 3-month treatment,the improvement of patients′skin lesions was estimated,and the vitiligo area and severity index(VASI)score and the Vitiligo European Task Force assessment tool(VETFa)were used to evaluate the efficacy.Patients with VASI changes≥0 and VETFa progression scores≤0 point were included in the glucocorticoid-sensitive group(i.e.,the patients′condition was stable or improved),otherwise those with VASI changes<0 and VETFa progression scores of 1 point were included in the glucocorticoid-resistant group.Associations of lesion locations,specific clinical markers(trichrome lesions,confetti-like depigmentation,and Koebner phenomenon),previous medication history,family history of vitiligo,etc.with the response to systemic glucocorticoid treatment were analyzed.At baseline and after 3-month treatment,peripheral blood samples were collected from the patients,and enzyme-linked immunosorbent assay was performed to detect the plasma levels of CXCL9 and CXCL10.Statistical analysis was carried out by using the chi-square test,Fisher′s exact test,binary logistic regression analysis,Mann-Whitney U test,and Wilcoxon signed-rank test.Results A total of 142 patients with vitiligo were enrolled,and 127 completed 3-month treatment,including 77 males and 50 females.T

关 键 词：白癜风 糖皮质激素类 趋化因子CXCL10 系统治疗 影响因素 

分 类 号：R758.41[医药卫生—皮肤病学与性病学]