Hamzavi Iltefat, Jain Hem, McLean David, Shapiro Jerry, Zeng Haishan, Lui Harvey
Division of Dermatology, Department of Medicine, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada.
Arch Dermatol. 2004 Jun;140(6):677-83. doi: 10.1001/archderm.140.6.677.
There is currently no quantitative tool for evaluating vitiligo treatment response using parametric methods.
To develop and apply a simple clinical tool, the Vitiligo Area Scoring Index (VASI), to model the response of vitiligo to narrowband UV-B (NB-UV-B) phototherapy using parametric tests.
Prospective, randomized, controlled, bilateral left-right comparison trial.
North American tertiary care, university-affiliated phototherapy center.
Patients older than 18 years with stable vitiligo involving at least 5% of their total body surface in a symmetric distribution.
Treatment with NB-UV-B was given 3 times a week to half of the body on all patients for either 60 treatments or 6 months. The contralateral side served as a no-treatment control.
Repigmentation was assessed using the VASI, which was based on a composite estimate of the overall area of vitiligo patches at baseline and the degree of macular repigmentation within these patches over time. The VASI was validated separately against physician and patient global assessments. The overall reductions in VASI for NB-UV-B and control groups were modeled by multilevel regression with random effects and compared parametrically.
The VASI scoring correlated well with both patient and physician global assessments (P =.05 and P<.001, respectively, using ordinal logistic regression). The extent of repigmentation after 6 months on the treated side was 42.9% (95% confidence interval, 26.7%-59.0%) vs 3.3% (95% confidence interval -19.3% to 30.0%) on the untreated side (P<.001). A significant difference between control and NB-UV-B groups was apparent within the first 2 months of therapy. The legs, trunk, and arms were much more likely to repigment than the feet and hands.
The VASI is a quantitative clinical tool that can be used to evaluate vitiligo parametrically. Patients treated with NB-UV-B can be expected to achieve approximately 42.9% repigmentation of their vitiligo after 6 months of treatment, with the greatest response being achieved over the trunk and nonacral portions of the extremities.
目前尚无使用参数方法评估白癜风治疗反应的量化工具。
开发并应用一种简单的临床工具——白癜风面积评分指数（VASI），使用参数检验对白癜风对窄谱中波紫外线（NB-UV-B）光疗的反应进行建模。
前瞻性、随机、对照、双侧左右比较试验。
北美三级医疗、大学附属光疗中心。
年龄大于18岁、白癜风病情稳定且对称分布累及全身表面积至少5%的患者。
对所有患者的身体一半部位每周进行3次NB-UV-B治疗，共60次治疗或6个月。对侧作为未治疗对照。
使用VASI评估色素再生情况，VASI基于基线时白癜风斑块总面积的综合估计以及这些斑块内随时间的黄斑色素再生程度。VASI分别与医生和患者的整体评估进行验证。通过具有随机效应的多水平回归对NB-UV-B组和对照组的VASI总体降低情况进行建模，并进行参数比较。
VASI评分与患者和医生的整体评估均具有良好的相关性（分别使用有序逻辑回归，P = 0.05和P<0.001）。治疗侧6个月后的色素再生程度为42.9%（95%置信区间，26.7%-59.0%），未治疗侧为3.3%（95%置信区间，-19.3%至30.0%）（P<0.001）。治疗开始后的前2个月内，对照组和NB-UV-B组之间存在显著差异。腿部、躯干和手臂比足部和手部更易出现色素再生。
VASI是一种可用于参数化评估白癜风的量化临床工具。接受NB-UV-B治疗的患者在治疗6个月后，白癜风预计可实现约42.9%的色素再生，躯干和四肢非手足部位的反应最为明显。
