自体黑素细胞移植治疗243例面颈部白癜风疗效及相关因素分析

目的评价自体纯培养黑素细胞移植治疗面颈部白癜风的疗效及其相关因素分析。方法负压吸疱获取患者正常表皮片，Hul6培养基体外培养黑素细胞，并检测黑素细胞的分裂时间。黑素细胞经2～5代体外培养后，受皮区应用超脉冲二氧化碳激光磨削去表皮后进行黑素细胞移植。所有患者均至少跟踪观察疗效6个月。结果共治疗243例面颈部白癜风患者，78．60％的皮损获得了50％以上的复色，55．97％的皮损获得了90％以上的复色。节段型白癜风患者移植痊愈率（66．13％）高于寻常型白癜风患者（52．49％，P=0．009）；病情稳定时间大于5年的患者移植痊愈率（62．50％）高于病情稳定时间小于1年（53．13％）和1～5年（53．33％）患者（均P〈0．05）；面部白癜风患者移植痊愈率（59．80％）高于颈部白癜风患者（47．30％，P=0．048）；黑素细胞分裂时间小于等于3.5d患者移植痊愈率（69．23％）高于黑素细胞分裂时间大于3．5d患者（49．70％，P=0．004）。移植疗效与患者年龄无明显相关性。结论自体纯培养黑素细胞移植是治疗面颈部白癜风的有效方法，其移植疗效与白癜风类型、病情稳定时间、皮损部位、黑素细胞分裂时间密切相关。

The therapeutic efficacy and risk factor analysis of autologous cultured pure melanocytes in the treatment of face and neck vitiligo

Objective To evaluate the effect of transplantation of autologous cultured melanocytes （TACM） in the treatment of vitiligo and the related factors. Methods Autologous donor skin sheets were obtained by suction blisters from the normal skin of the abdomen in vitiligo patients. The melanocytes isolated were cultured in the Hul6 media, and the division time of these melanocytes was detected. After 2 to 5 passages, the autologous melanocytes cultured were transplanted to the vitilinous lesions of the patients which were previously abraded by ultra-plused carbon dioxide laser. All patients were followed up for at least 6 months. Results Two hundred and forty-three vitiligo patients were treated with TACM. The repigmentation up to 90% or more was seen in 55.97% of the lesions, and the repigmentation over 50% was seen in 78.60% of the lesions. The repigmentation over 90% was accounting for 66. 13% of segmental lesions, while accounting for 52. 49% of non segmental lesions （ P = 0. 009）. A higher cure rate was seen in those with stable disease over 5 years than those less than 5 years （ P 〈 0.05 ）. The therapeutic results in lesions located on the face was superior to that on the neck. Similarly, a superior efficacy was found in patients receiving melanoeytes with shorter division time （ ≤ 3.5 d） to those receiving melanocytes with longer division time （ 〉 3.5 d, P = 0. 004）. No correlation was noted between the therapeutic responses and the age of patients. TACM is effective in the treatment of stable face and neck vitiligo. The therapeuticefficacy was related to types of vitiligo, length of stablized disease, locations and sizes of lesions, and the division time of cultured melanocytes.