308 nm准分子激光与308 nm准分子光治疗194例儿童白癜风的疗效及安全性回顾分析  

Efficacy and safety of 308-nm excimer laser and 308-nm excimer lamp in the treatment of 194 children with vitiligo: a retrospective study

作　　者：罗莉 张博娜 吴畏 汤文静 李岳华 刘晓莉 马雅楠 李翠翠 齐梦岩 孙妮 石琼 Luo Li;Zhang Bona;Wu Wei;Tang Wenjing;Li Yuehua;Liu Xiaoli;Ma Yanan;Li Cuicui;Qi Mengyan;Sun Ni;Shi Qiong(Department of Dermatology,Xijing Hospital,Air Force Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学西京皮肤医院,西安710032

出　　处：《中华皮肤科杂志》2024年第8期721-727,共7页Chinese Journal of Dermatology

摘　　要：目的评价308 nm准分子光及308 nm准分子激光治疗儿童白癜风的疗效及安全性。方法回顾性分析2010—2015年就诊于西京皮肤医院接受靶向光疗的稳定期白癜风患儿的临床资料。患儿均采用308 nm准分子激光/308 nm准分子光治疗,同时联合局部药物治疗,治疗时间均≥3个月,随访≥6个月。采用白癜风面积及严重程度指数(VASI)评价白癜风严重程度,治疗3个月后评估疗效,以VASI评分较基线下降≥50%(达VASI50及以上)为“有效”。以治疗有效与否做因变量,构建logistic回归模型,筛选与疗效相关的因素。配对样本秩和检验用于治疗前后偏态数据的比较。治疗过程中同时记录不良反应,以评估靶向光疗的安全性。结果最终纳入稳定期白癜风患儿194例,包括男103例(53.1%)、女91例(46.9%),年龄6~14(10.2±2.3)岁。138例(71.1%)患儿采用308 nm准分子激光治疗,56例(28.9%)采用308 nm准分子光治疗。194例患儿基线VASI评分[M(Q1,Q3)]为0.12(0.05,0.40),治疗3个月后VASI评分[0.06(0.02,0.19)]显著低于基线评分(Z=12.02,P<0.001)。治疗3个月后,52例达VASI50,30例达VASI75,总有效率为42.3%(82/194);308 nm准分子激光组38例达VASI50,26例达VASI75,有效率为46.4%(64/138);308 nm准分子光组14例达VASI50,4例达VASI75,有效率为32.1%(18/56)。单因素logistic回归分析显示,相较于四肢白斑,头颈部、躯干部位白斑更易复色(OR=3.56,95%CI:1.15~11.02,P=0.027;OR=6.58,95%CI:1.81~23.96,P=0.004);相较于面部其他部位的白癜风,眶周白斑更易复色(OR=4.58,95%CI:1.10~19.11,P=0.037);与无毛发累及的头颈部白斑相比,有毛发累及者不易复色(OR=0.31,95%CI:0.13~0.75,P=0.010)。多因素logistic回归分析显示,眶周可能是面部白斑的最佳复色部位(OR=5.37,95%CI:1.18~24.34,P=0.029),且头颈部白斑有毛发累及是影响光疗复色的独立危险因素(OR=0.28,95%CI:0.08~0.96,P=0.042)。194例稳定期白癜风患儿经靶向光疗3个月,33例出现短期治�Objective To evaluate the efficacy and safety of 308-nm excimer lamp and 308-nm excimer laser in the treatment of pediatric vitiligo.Methods Clinical data were collected from children with stable vitiligo who received targeted phototherapy at the Department of Dermatology of Xijing Hospital from 2010 to 2015,and retrospectively analyzed.The patients were treated with either 308-nm excimer laser or 308-nm excimer lamp,and all were given topical drugs.The treatment lasted for at least 3 months,and follow-up for at least 6 months.The severity of vitiligo was assessed using the Vitiligo Area and Severity Index(VASI)score.The efficacy was evaluated after 3 months of treatment,and at least a 50%reduction in the VASI score(VASI50)was defined as“effectiveness”.A logistic regression model was constructed using treatment efficacy as the dependent variable to screen factors related to the treatment outcome.The Wilcoxon signed-rank test was used to compare skewed data before and after treatment.Adverse reactions during treatment were recorded to evaluate the safety of targeted phototherapy.Results A total of 194 children with stable vitiligo were included,comprising 103 males(53.1%)and 91 females(46.9%),with the age being 6 to 14(10.2±2.3)years.Among them,138(71.1%)received 308-nm excimer laser therapy,while 56(28.9%)received 308-nm excimer lamp therapy.The VASI score(M[Q1,Q3])was 0.12(0.05,0.40)at the baseline,significantly decreased to 0.06(0.02,0.19)after 3 months of treatment(Z=12.02,P<0.001).After 3 months of treatment,52 patients achieved VASI50,and 30 achieved VASI75,resulting in an overall response rate of 42.3%(82/194).Specifically,in the 308-nm excimer laser group,38 patients achieved VASI50 and 26 achieved VASI75,with a response rate of 46.4%(64/138);in the 308-nm excimer lamp group,14 patients achieved VASI50 and 4 achieved VASI75,yielding a response rate of 32.1%(18/56).Univariate logistic regression analysis indicated that lesions located on the head and neck or the trunk were more prone to repigmentation

关 键 词：白癜风 儿童 光疗法 308 nm准分子激光 308 nm准分子光 治疗结果 安全性 影响因素 

分 类 号：R758.41[医药卫生—皮肤病学与性病学]