中国白癜风患者临床标志物与疾病进展的相关性研究。
Association of Clinical Markers With Disease Progression in Patients With Vitiligo From China.
机构信息
Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China.
出版信息
JAMA Dermatol. 2020 Mar 1;156(3):288-295. doi: 10.1001/jamadermatol.2019.4483.
IMPORTANCE
It is necessary to determine whether established clinical markers of vitiligo are associated with disease progression, severity, and patient prognosis.
OBJECTIVE
To evaluate the utility of trichrome sign, confetti-like depigmentation, and Koebner phenomenon in assessing disease progression, severity, and prognosis in patients with vitiligo.
DESIGN, SETTING, AND PARTICIPANTS: In this prospective cohort study, 425 patients with vitiligo were recruited from the outpatient department of Huashan Hospital, Fudan University in Shanghai, China, from September 1, 2016, to May 13, 2019.
MAIN OUTCOMES AND MEASURES
Disease progression, severity, and prognosis during a 12-month period. The active stage of vitiligo was defined as Vitiligo European Task Force spreading score of at least 1 or more lesions appearing as hypomelanotic with poorly defined borders using a Wood light. Progression was assessed using the Vitiligo Area Scoring Index (VASI) and serum CXCL10 level measurement.
RESULTS
Of the 458 enrolled patients, 425 (235 female [55.3%]; mean [SD] age, 30.9 [10.2] years) completed the 12-month follow-up. Of the 425 patients (224 with no clinical marker and 201 with at least 1 clinical marker) included in this analysis, the proportion in the active stage of the disease was significantly higher in the cohort with at least 1 clinical marker compared with the cohort without any clinical marker at the first visit (196 of 201 [97.5%] vs 159 of 224 [71.0%]; P < .001) and at 3-month follow up (91 of 201 [45.3%] vs 52 of 224 [23.2%]; P < .001). The proportion of patients with rapid disease progression was also higher in the group with at least 1 clinical marker at 1-month follow-up (142 of 201 [70.6%] vs 60 of 224 [26.8%]; P < .001) and 3-month follow-up (63 of 201 [31.3%] vs 9 of 224 [4.0%]; P < .001). The improvement in VASI score (SD) was significantly smaller among patients with at least 1 clinical marker compared with those without any clinical marker at 6 months (mean [SD], 0.14 [0.12] vs 0.23 [0.21]; P = .02), at 9 months (mean [SD], 0.29 [0.19] vs 0.44 [0.25]; P = .03), and at 12 months (mean [SD], 0.47 [0.21] vs 0.63 [0.23]; P = .03).
CONCLUSIONS AND RELEVANCE
The presence of a clinical marker in patients with vitiligo may be associated with worse prognosis and rapid disease progression. Patients with multiple clinical markers may require more intensive treatment.
重要性
有必要确定已建立的白癜风临床标志物是否与疾病进展、严重程度和患者预后相关。
目的
评估三色征、糠疹样脱色斑和柯氏现象在评估白癜风患者疾病进展、严重程度和预后中的作用。
设计、地点和参与者：在这项前瞻性队列研究中，2016 年 9 月 1 日至 2019 年 5 月 13 日，从中国上海复旦大学华山医院的门诊部招募了 425 名白癜风患者。
主要结局和测量指标
12 个月期间的疾病进展、严重程度和预后。白癜风的活动期定义为使用伍德灯时，至少有 1 个病变出现边界不清的色素减退，且边界不清，维特利诺欧洲工作组扩散评分至少为 1 分。进展情况通过维特利诺面积评分指数（VASI）和血清 CXCL10 水平测量进行评估。
结果
在纳入的 458 名患者中，425 名（235 名女性[55.3%]；平均[标准差]年龄，30.9[10.2]岁）完成了 12 个月的随访。在这 425 名患者（224 名无临床标志物和 201 名至少有 1 个临床标志物）中，至少有 1 个临床标志物的患者中，在第一次就诊时，疾病活动期的比例明显高于无任何临床标志物的患者（201 名中的 196 名[97.5%]比 224 名中的 159 名[71.0%]；P<0.001）和 3 个月随访时（201 名中的 91 名[45.3%]比 224 名中的 52 名[23.2%]；P<0.001）。在 1 个月随访时（201 名中的 142 名[70.6%]比 224 名中的 60 名[26.8%]；P<0.001）和 3 个月随访时（201 名中的 63 名[31.3%]比 224 名中的 9 名[4.0%]；P<0.001），有至少 1 个临床标志物的患者中，疾病快速进展的比例也更高。与无任何临床标志物的患者相比，至少有 1 个临床标志物的患者在 6 个月（平均[标准差]，0.14[0.12]比 0.23[0.21]；P=0.02）、9 个月（平均[标准差]，0.29[0.19]比 0.44[0.25]；P=0.03）和 12 个月（平均[标准差]，0.47[0.21]比 0.63[0.23]；P=0.03）时，VASI 评分（标准差）的改善幅度明显较小。
结论和相关性
白癜风患者存在临床标志物可能与预后较差和疾病快速进展相关。有多个临床标志物的患者可能需要更强化的治疗。
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