压力对白癜风负压吸疱自体表皮移植的影响

负压吸疱自体表皮片移植是治疗稳定期白癜风常用方法之一.供皮区一般选择腹部、臀部等不影响美容的部位.我们通过观察不同压力下腹部起疱情况、真表皮分离部位,黑素细胞培养观察黑素细胞数量,寻求腹部起疱最合适的压力,从而提高负压吸疱移植治疗白癜风的疗效.     

吸疱法与磨削法表皮移植治疗白癜风疗效比较

吸疱法与磨削法表皮移植治疗白癜风疗效比较黄凤云①白癜风是一种常见皮肤病，目前药物治疗对局限型患者疗效较差。１９８５年国外学者［１］采用自体表皮移植治疗白癜风获得成功，证明黑素细胞可以通过水疱表皮移植到白斑处。我们于１９９５年４月～１９９６年６月对１５...     

自体表皮移植治疗白癜风和老年疣

1964年Kiistala报告负压吸引产生表皮下水疱后,用其水疱顶自体表皮移植治疗白癜风、特发性点状色素减少症、炎症后白斑和斑驳病等色素性皮肤病的报告很多。Suvanprakorn等报告用负压吸引发疱法进行自体表皮移植,皮片的成活率高(84%),唯要求供受皮区部位平整;液氮法虽基本不受部位限制,但成活率较低(50%)。为此,我们根据受皮区部位,采用负压吸引或液氮冷冻发疱法;而供皮区均采用负压吸引发疱法,自1989年以来,对38例白癜风和6例老年疣进行了自体表皮移植。现将结果报告如下。     

加温负压吸疱自体表皮移植法治疗白癜风27例疗效观察

我科在1991年曾以负压吸疱法进行自体表皮移植治疗白癜风取得初步成功,但手术时间较长。1992年起采用了加温负压吸引法使水疱形成时间大为缩短,乃使此法得以推广。到1994年底我们共计治疗患者27例。移植表皮片总数102片,取得了较理想的效果。现将所用方法及结果报告如下。     

负压吸疱法自体表皮移植联合NB-UVB治疗白癜风疗效分析

目的观察负压吸疱法自体表皮移植联合NB-UVB治疗稳定期白癜风的疗效。方法治疗组予负压吸疱法自体表皮移植,再行NB-UVB照射;对照组予负压吸疱法自体表皮移植。疗程3个月。随访3个月。结果治疗组总有效率98.02%,对照组总有效率89.05%,两组比较差异有非常显著性(P<0.05)。结论负压吸疱法自体表皮移植联合NB-UVB治疗稳定期白癜风疗效优于单用负压吸疱法自体表皮移植。     

吸引发疱法自体表皮移植治疗白癜风

吸引发疱法自体表皮移植治疗白癜风涂彩霞，林熙然（指导）大连医科大学附属一院皮肤科（邮政编码１１６０１１）近年来，我们应用负压吸引发疱法，对２５例白癜风患者做了自体表皮移植，取得了一定的疗效。现将结果报告如下。病例和方法病例为对其他疗法无效，且处于非活...     

表皮移植治疗泛发性白癜风

本文报道采用负压吸引引起疱表皮移植方法治疗白癜风,取得明显的色素沉着且无瘢癜形成。接受治疗的病人为18例对其他治疗抵抗的白癜风患者,年龄6～69岁,病程2～30年,平均为11年。其中局限型2例,节段型5例,泛发型11例。治疗方法;在植皮前1天或3天于白癜风皮损处,用液氮或外用PUVA 产生约2cm 大小的水疱。在植皮的当日于腹部或股部应用负压吸引,形成2cm直径的水疱,然后,将接受植皮部的水疱除去疱壁,再取供皮处的水疱表皮放置于接受植皮、并已除去疱壁的糜烂面上。无菌压迫敷盖4～5天,根据皮损     

白癜风负压吸疱自体表皮移植的影响因素

负压吸疱自体表皮移植是目前广泛使用的稳定期白癜风治疗方法之一,具有成功率高,并发症少的优点,其疗效受多种因素影响.主要包括:负压吸疱条件如吸疱部位、温度、压力、吸疱时间等;受皮区的磨削技术;术中、术后汴意事项;术前或术后选择联合的不同治疗方法.这些因素之间亦相互作用,影响皮片内黑素细胞的含量和成活率,进而影响皮肤移植区着色程度和色素扩展范围.     

白癜风的移植治疗

白癜风移植治疗的目的是将正常皮肤内的黑素细胞移植到没有黑素细胞的白斑区。主要分为组织移植和细胞移植 ,及介于两者之间培养的表皮片移植。组织移植包括全厚层钻孔移植、刃厚皮片移植、负压吸疱移植和单株毛发移植 ,细胞移植包括表皮细胞悬液移植和培养的黑素细胞移植。现将各种移植方法作一综述     

白癜风的移植治疗

白癜风移植治疗的目的是将正常皮肤内的黑素细胞移括蓟没有黑素细胞的白斑区。主要分为组织移植和细胞移植，及介于两者之间培养的表皮片移植。组织移植包括全厚层钻孔移植、刃厚皮片移植、负压吸疱移植和单株毛发移植，细胞移植包括表皮细胞悬液移植和培养的黑素细胞移植。现将各种移植方法作一综述。     

个体化培养自体黑素细胞移植治疗白癜风

目的 探讨使用个体化培养基进行自体黑素细胞培养移植治疗白癜风的疗效。方法 负压吸疱获取患者正常表皮片,制成细胞悬液,在Hu16黑素细胞选择性培养基中培养。检测黑素细胞分裂时间（DOT）和黑素含量,根据DOT的大小、黑素含量和细胞形态,调整血清、细胞因子浓度及补充内皮素-1,进行个体化黑素细胞培养。经2 ~ 5次传代后收集黑素细胞,白斑区用超脉冲CO2激光磨削后进行黑素细胞移植,随访观察复色效果。结果 共治疗155例稳定期白癜风患者的204处皮损,进行1次移植119例,进行2 ~ 4次移植36例。应用个体化黑素细胞培养后细胞扩增可达50 ~ 80倍。84.80%的皮损复色面积超过50%,其中52.94%的皮损复色面积超过90%,且复色均匀,未见瘢痕及其他不良反应。性别、年龄、病程长短和皮损面积大小对疗效没有影响。节段型白癜风移植疗效好于寻常型白癜风,两组有效率分别为93.62%和82.16%,痊愈率分别为65.96%和49.04%。手臂和腿部的皮损（不包括肘部和膝盖）移植后痊愈率达73.08%,疗效好于躯干、面颈;肢端皮损疗效最差,痊愈率仅为25.93%。结论 个体化培养技术能提高白癜风患者黑素细胞的培养成功率与细胞扩增倍数。体外培养的自体黑素细胞移植治疗稳定期白癜风疗效肯定,用少量供皮区即可治疗大面积皮损,值得临床应用。     

自体黑素细胞体外培养移植治疗白癜风

目的 探讨自体黑素细胞体外培养扩增和移植治疗白癜风的疗效.方法 用负压吸疱法在白癜风患者正常皮肤区吸疱取皮,用胰蛋白酶消化皮肤制成细胞悬液,在M2黑素细胞选择性培养基中培养,每周传代1次,经4～5次传代,以免疫荧光和多巴胺染色检测培养细胞的纯度和生物学特性.观察培养的自体黑素细胞移植到白癜风患者皮损区后色素生成效果.结果 黑素细胞能在培养基中选择性生长,经4～5周培养,获得纯的黑素细胞,无成纤维细胞和角质形成细胞污染.16例患者28个皮损区接受了移植治疗,病变皮肤面积从2cm²到200 cm²,1个月后移植区出现部分色素,呈淡红色.所有皮损区在移植后3～5个月均有色素再生,色素水平较周围正常皮肤略深或稍浅,6～8个月时色素恢复稳定,颜色与临近正常皮肤接近.87.5%皮损区色素再生面积超过50%.未见瘢痕和其他不良反应.结论 自体黑素细胞体外培养移植治疗白癜风具有效果好、安全、取较小表皮可以治疗较大面积皮损区的优点.     

Treatment of vitiligo with khellin liposomes,ultraviolet light and blister roof transplantation

Background Various surgical and non‐surgical methods are available to treat vitiligo. Surgical techniques such as epidermal blister graft transplantation may be effective for the re‐pigmentation of stable, but refractory vitiligo areas. Khellin has phototherapeutic properties that are similar to those of the psoralens, but with substantially lower phototoxic effects and DNA mutation effects. Its penetration into the hair follicles is enhanced by encapsulating it into liposomes. Subsequent activation of the khellin with UV light stimulates the melanocytes in the hair follicles. Objective The first objective was to evaluate the additional value of combining blister roof transplantation (BRT) with khellin in liposomes and ultraviolet light (KLUV) in the treatment of recalcitrant vitiligo patches. The second objective was to assess patients’ satisfaction. Materials and methods Nineteen patients with vitiligo lesions which did not respond to KLUV treatment for at least a year were treated with BRT followed by KLUV. The transplantation was performed by creating blisters with a suction device, preparing the target site with Erbium laser ablation and the actual transplantation. Locations where randomly assigned. A blinded observer established the results. Results Seventy‐five percent of the patients were satisfied with the cosmetic result. All of the patients would recommend the treatment to other vitiligo patients. More than 75% re‐pigmentation of the vitiligo areas was noted in 47% of the patients according to the blinded evaluation of photographs taken before and after the treatment.     

白癜风同种异体黑细胞移植初步研究

目的 探索同种异体黑素细胞移植治疗稳定期白癜风的可行性。方法 用负压吸疱法在白癜风患者白斑区吸疱，注入纯培养的同种异体黑素细胞悬液，连续观察外观效果，并做组织病理学和免疫学检查，通过PCR扩增Y染色体特异性片段方法确定异体黑细胞的转归。结果 1月后移植区出现部分色素，两个半月时色素恢复明显，至半年时恢复的色素稳定存在，且颜色与邻近正常皮肤接近。组织病理显示移植区基底层有黑素细胞存活，黑素细胞周围的角质形成细胞内有黑素颗粒。疱皮组织DNA检查有Y染色体特异性片段。结论 同种异体黑素细胞移植治疗白癜风具有可行性，值得进一步探讨。     

Autologous epidermal grafting with PUVA-irradiated donor skin for the treatment of vitiligo

Background Epidermal autografting has been used to treat vitiligo. The pigmentation achieved at the recipient site can be variegated and incomplete compared with that of the surrounding normal skin, and sometimes remains that way for a fairly long time. Objective We investigated whether the clinical results from epidermal autografting are related to a change in the number of melanocytes. This was performed by counting the number of melanocytes in the epidermis obtained from biopsy and suction with and without psoralen plus UVA (PUVA) exposure of the donor sites before grafting. Methods The numbers of melanocytes in the epidermis were counted after staining with dopa. The epidermis from suction and biopsy was included. The biopsied specimen was treated with NaBr for dermo–epidermal separation before staining, whereas the epidermis obtained from suction was stained directly. Results The epidermis obtained from suction contained 40–60% of the number of melanocytes found in the biopsied epidermis. Melanocytes around the hair follicles seemed to be omitted. Treatment with PUVA 10–21 times caused the number of melanocytes to increase by 1.5–2 times the normal level with a promising clinical result. Conclusions The preparation of donor sites with PUVA before the treatment of vitiligo by epidermal autografting induced an increased number of melanocytes and improved the clinical result.     

白癜风表皮黑素细胞超微结构及小眼畸形相关转录因子转录调控研究

目的 研究白癜风黑素细胞超微结构和小眼畸形相关转录因子 （MITF）及其转录调控的酪氨酸酶相关蛋白（TRP）与白癜风临床类型与病程的相关性。方法 选择不同病程的寻常型白癜风（VV）12例和节段型白癜风（SV）8例,分别取白斑区、白斑边缘正常肤色区和远离白斑正常肤色区的表皮片,经组织学确定其表皮的完整性。透射电镜观察10例患者（VV 6例,SV 4例）不同区表皮黑素细胞的超微结构特点。对所有20例远离白斑正常肤色区的表皮片黑素细胞进行培养,应用免疫印迹方法检测 MITF及其转录调控的酪氨酸酶（TYR）、酪氨酸酶相关蛋白1（TYRP1）和酪氨酸酶相关蛋白2（TYRP2）的表达水平。结果 白癜风表皮黑素细胞超微结构病理改变：10例中7例白斑区表皮内未见黑素细胞,1例短病程和2例长病程VV分别可见少量黑素体显著减少或缺失的黑素细胞;白斑边缘正常肤色区,6例VV中,3例病程小于15个月者可见黑素细胞超微结构异常,而4例SV中仅1例异常;远离白斑正常肤色区,10例黑素细胞超微结构均正常。白癜风表皮黑素细胞MITF及其转录调控TRP的表达：VV的MITF表达下调与TYR、TYRP1、TYRP2的表达下调一致;SV存在MITF显著表达下调,而TYR、TYRP1、TYRP2几均正常表达。结论 VV和SV可能存在不同的表皮黑素细胞超微结构病理改变和MITF转录调控机制。     

Long-term follow-up of leucoderma patients treated with transplants of autologous cultured melanocytes,ultrathin epidermal sheets and basal cell layer suspension

BACKGROUND: In vitiligo and piebaldism the lack of melanin in the epidermis is due to the fact that melanocytes are missing. The patients suffer psychologically and the white areas have lost the part of the skin barrier protection normally provided by the melanocytes. Medical treatments are ineffective in many of the patients, and surgical methods have therefore been developed. OBJECTIVES: It is important to investigate the long-term results and factors that might influence the outcome of melanocyte transplantations in order to form a basis for guidance in the selection of patients who will benefit most from the treatments. METHODS: A follow-up of 132 patients who had been treated by transplantation on 176 occasions in total, 1-7 years previously, was carried out by questionnaires and clinical examinations. We investigated the responses in five types of leucoderma to three different transplantation methods: autologous cultured melanocytes, ultrathin epidermal sheets and basal layer cell suspension. RESULTS: Stable types of leucoderma, i.e. segmental vitiligo and piebaldism, responded in most cases with 100% repigmentation, regardless of the surgical method used. For these types of leucoderma surgery seems to be the method of choice. The largest group, vitiligo vulgaris, was thoroughly scrutinized and three statistical models were used to analyse the data. The ultrathin epidermal sheet method gave somewhat better overall results, but was the method that gave the worst outcome in knee and elbow areas, emphasizing the importance of the right choice of method depending on the anatomical location to be treated. Irrespective of the method, fingers and elbows were the most difficult areas to repigment. The trunk and the arms and legs (not including elbows and knees) responded best. Patients with increasing and/or extensive vitiligo vulgaris more often showed incomplete repigmentation. They also had a lower chance of retaining their repigmentation compared with those with less extensive vitiligo. Patients in whom untreated white lesions had increased in recent years tended to respond less well to transplantation compared with patients with unchanged or decreased lesions. Within the vitiligo vulgaris group, patients with short disease duration or with small total vitiligo area responded best to transplantation. The subgroup of vitiligo vulgaris patients with hypothyroidism tend to respond less well to the transplantation and they were generally older at vitiligo onset. This information is of great importance for the selection of patients and when informing about the chances of improvement after transplantation. Slight hyperpigmentation was common, especially when ultrathin epidermal sheets had been used. No scars or indurations were seen in treated areas. CONCLUSIONS: Transplantations are the methods of choice in stable types of leucoderma. Progressive, widespread vitiligo vulgaris should never be selected for transplantation.     

Vitiligo and idiopathic guttate hypomelanosis. Repigmentation of skin following engraftment onto nude mice

Several diseases are included in the category of hypomelanosis. Their clinical course as well as the pathogenesis are diverse and in many cases poorly understood. The aim of the present study is to use the nude mice model to determine whether the primary defect in various pigmentary skin disorders is inherent to the tissue itself or is secondary to systemic factors. Split-thickness skin grafts obtained from patients with vitiligo, acquired hypomelanosis guttata, and tyrosinase-negative albinism were grafted onto nude mice. Histologic examination and dopa staining were performed prior to and following the engraftment. The dopa staining was performed on the epidermal sheet following separation from the dermis. The depigmented area of the vitiligo became completely pigmented 6 to 10 weeks after skin transplantation. The dopa reaction that was negative prior to skin engraftment became completely positive after the transplantation. The number of melanocytes (expressed per square millimeter of skin surface) 8 weeks after transplantation was 197 +/- 73 mm2. Dopa reaction in acquired hypomelanosis guttata showed reduction of the number of melanocytes in the depigmented macula as compared with the surrounding area (55.25 +/- 18.00 mm2 vs 220 +/- 28.28 mm2. Twenty days after skin transplantation, repigmentation of the area was observed. The number of melanocytes increased significantly (388.75 +/- 213 mm2). The grafted skin obtained from patients with tyrosinase-negative albinism showed persistence of the depigmentation after skin transplantation. Dopa reaction was negative prior to and 8 weeks after transplantation. The results of the present study suggest that systemic factors may play a role in the pathogenesis of vitiligo and acquired hypomelanosis guttata.     

Study of CCN3 (NOV) and DDR1 in normal melanocytes and vitiligo skin

We have hypothesised that melanocytes disappear in vitiligo because they are weakly attached to the epidermal basal membrane (melanocytorrhagy). In the epidermis, attachment of melanocytes to collagen IV is mediated through DDR1, which is under the control of CCN3. DDR1 genetic variants have been associated with vitiligo in patients of different ethnic origin. In vitro studies have shown that inhibition of CCN3 induces the detachment of melanocytes. We have studied in parallel the expression of CCN3 and DDR1 in lesional and perilesional skin of patients with vitiligo and the impact of the silencing of CCN3 and DDR1 in normal human melanocytes on their behaviour in epidermal reconstructs. Our in vivo study provides evidence of a dysregulation of the DDR1-CCN3 interaction in vitiligo skin as melanocytes remaining in perilesional skin did not express CCN3. Expression of DDR1 was decreased in lesional versus perilesional vitiligo skin in the majority of patients, and the expression of collagen IV was found decreased in all patients. Silencing of CCN3 in melanocytes induced a significant inhibition of cell adhesion to collagen IV whereas melanocytes transduced with shDDR1 still adhered well on collagen IV and did not increase melanocyte loss in epidermal reconstructs as compared with normal melanocytes. Melanocyte detachment was observed but not in all reconstructs using CCN3 silenced melanocytes. Overall, our study confirms that a downregulation of CCN3 is implicated in melanocyte adhesion in part through DDR1. In vitiligo skin, the interaction of CCN3 with other molecules, such as TGFβ and CCN2, needs to be addressed.