81例未成年人白癜风分析

目的 探讨未成年人白癜风患者临床特点及疗效。方法 从81例未成年人白癜风患者的性别构成、年龄分布、发病年龄、皮损分布部位、皮损分期及分型、家族史、免疫功能、病理及免疫病理、疗效等方面进行分析。结果81例未成年人白癜风患者男女性别构成约为1∶1.6。发病年龄最小6个月。各年龄段均可发病。皮损可累及人体多个部位包括黏膜,但以躯干及面部为多。寻常型明显较节段型多,寻常型者中又以局限型者为多。稳定期者较进行期者为多。不完全型较完全型者多。12例有家族史,但无明显家族遗传特征。3例白癜风患者免疫病理显示：基底膜带IgG沉积。在各型白癜风中局限性白癜风疗效最佳,肢端性及节段型次之而散发性、泛发性白癜风疗效较差。治疗起效时间最短2w,最长1m。治疗3m后痊愈14例（17.28%）,显效23例（28.40%）,有效率45.68%。结论 未成年人白癜风患者发病年龄小,病因不清,部分患者有家族史或免疫功能异常,疗效有待提高。     

1005例白癜风患者遗传因素的调查

目的 探讨白癜风患者发病过程中遗传因素所起的作用。方法 采用问卷调查方法收集1997年9月至2009年3月于我科门诊就诊的1005例白癜风确诊患者的临床资料,应用SPSS 13.0软件对所得数据进行统计学分析。结果 本调查的1005例白癜风先证者中,有家族史者206例,占20.5%。家族史阳性者的平均发病年龄（24.45 ± 15.87岁）比家族史阴性者（28.12 ± 16.88岁）小（P < 0.05）。家族史阳性者皮损双侧分布的比例比家族史阴性者高（71.3%比60.8%）（P < 0.05）。家族史阳性者以B型血居多（19.9%）,家族史阴性者以O型血居多（16.8%）（P > 0.05）。结论 ①白癜风的发病符合多基因遗传规律,具有家族聚集性,且血缘关系愈近,其发病率愈高。②白癜风的发病与性别无关。③家族史阳性者的平均发病年龄较家族史阴性者小,父系或母系遗传对发病年龄无影响。④家族史阳性者皮损双侧分布的比例较家族史阴性者高,而对其他临床表现无影响。     

白癜风患者215例临床分析

目的：总结白癜风患者的临床特点和发病诱因.方法：对确诊的白癜风患者进行问卷设计和调查,用SPSS 11.5软件包进行统计分析.结果：资料完整的215例白癜风患者中男98例,女117例;平均发病年龄18.76±7.43岁;最常见的受累部位为上肢（54.42%）;伴发疾病中以甲状腺疾病最常见（5.58%）;有家族史者占13.02%,有家族史患者发病年龄为14.6±4.31岁,无家族史为25.09±5.45岁（P〈0.001）,两者间有显著性差异;春夏季发病最常见;25.58%的患者可发现诱因,其中常见的诱因包括精神因素 （43.64%）和皮肤损伤（56.36%）.结论：本地区白癜风好发于青少年,有家族史患者发病年龄早于无家族史患者,上肢为最常见的好发部位,可能与精神因素和皮肤外伤、日晒伤有关.     

白癜风243例临床分析

目的:了解白癜风的临床特点、发病诱因及相关实验室检查结果,为探讨其发病机制及制定防治措施提供依据。方法:收集2016年1月-2019年1月我科门诊的243例白癜风患者临床资料,包括性别、年龄、病史、家族史、伴发疾病及实验室检查结果、治疗疗效等,用SPSS 19.0软件进行统计学分析。结果:243例患者中:寻常型227例(93.42%),为发病的主要类型,节段型16例(6.58%);进展期187例(76.95%),稳定期56例(23.05%);患者各部位均可累及但以曝光部位高发;皮损面积轻度最常见(175例,72.02%);48例(19.75%)有阳性家族史,49例(20.16%)有并发疾病,104例(42.80%)有明显诱发因素,其中神经精神因素为主要诱因。60例(24.69%)有微量元素异常,以锌含量降低最常见;28例(11.52%)合并甲状腺功能异常,40例(16.46%)抗甲状腺抗体阳性。结论:精神神经应激、自身免疫异常及家族史可能是白癜风发病的始动因素,病程长、肢端皮损或合并毛发变白及黏膜受累病例的治疗仍面临巨大挑战,系统治疗联合点阵激光局部药物导入及紫外线照射是白癜风有效的治疗方法。     

沈阳地区95例白癜风的临床研究及HLA-I抗原检测

本组95例白癜风是以10-20岁为发病高峰，其中65例（68.42%）发病前有诱发因素，以精神紧张及思虑过度占首位。6例（6.32%）伴发晕痣。有明确家族史者20例（21.05%),发生皮损早于无家族史者。白癜风与HLA-1类抗原相关。提示白癜风发病与免疫、遗传、神经精神因素有关。     

寻常型白癜风365例临床资料分析

目的分析寻常型白癜风患者的临床特征,探求影响寻常型白癜风发病和病情轻重的可能相关因素。方法制作寻常型白癜风患者临床和流行病学调查问卷,调查分析365例寻常型白癜风患者。结果 365例白癜风中男性193例,女性172例,有家族史者48例;就诊时皮损面积大小以占体表面积的1%～5%最为多见,男性平均皮损面积大于女性(χ2=13.99,0.01P0.05);有诱发因素者82例,以精神紧张和精神抑郁为主。结论白癜风发病可能与遗传、情绪、精神变化等因素有关。     

培养的自体黑素细胞移植治疗伴自身免疫性甲状腺疾病的非节段型白癜风患者的疗效及安全性随访

【摘要】 目的 探讨培养的自体黑素细胞移植治疗伴自身免疫性甲状腺疾病的白癜风患者的临床疗效及安全性。方法 回顾2008年5月至2018年12月杭州市第三人民医院行培养的自体黑素细胞移植治疗的2 284例非节段型白癜风,其中伴自身免疫性甲状腺疾病75例,包括甲状腺功能亢进42例,甲状腺功能减退18例,桥本甲状腺炎15例。比较伴自身免疫性甲状腺疾病组与不伴自身免疫性甲状腺疾病组的疗效及安全性。计数资料的比较采用χ2检验。结果 2 284例患者中,男1 085例,女1 199例,年龄（25.0 ± 1.2）岁,病程（5.1 ± 2.3）年。术后6个月,2 209例不伴自身免疫性甲状腺疾病组中1 873例有效（84.8%）、1 162例痊愈（52.6%）;伴自身免疫性甲状腺疾病组46例有效（61.3%）、20例痊愈（26.7%）,伴自身免疫性甲状腺疾病组有效率及痊愈率均低于不伴自身免疫性甲状腺疾病组（χ2值分别为29.72、19.54,均P < 0.001）。甲状腺功能减退组有效率低于甲状腺功能亢进组（χ2 = 6.61,P = 0.010）。伴自身免疫性甲状腺疾病组供皮区同形反应发生率（9.3%）高于不伴自身免疫性甲状腺疾病组（4.3%,χ2 = 4.31,P = 0.038）,且移植部位1、3、5及10年白斑复发率（6.7%、14.7%、17.3%、8.7%）均高于不伴自身免疫性甲状腺疾病组（0.7%、1.4%、2.1%、3.6%,χ2值分别为29.96、70.69、67.23、41.61;均P < 0.001）。结论 伴发自身免疫性甲状腺疾病对于白癜风的自体黑素细胞移植治疗具有负相关效应,针对该类患者更应积极采取有效的预防同形反应和移植区复发的手段。     

白癜风287例临床分析

目的分析白癜风患者的临床特点及发病诱因,为制定防治措施提供依据。方法对2010年10月-2011年10月本科门诊的287例白癜风患者临床资料进行分析,内容包括性别、年龄、病史、发病部位、家族史、伴发疾病及诱因,用SPSS17.0软件进行统计学分析。结果男143例,女144例,平均发病年龄(18.9±14.4)岁,4～8岁为高峰发病期(14.29%)。寻常型白癜风有272例(94.77%)。患者全身各部位均可发病,但曝光部位(头、面、颈及手足)发病率较高,占67.25%。33例有阳性家族史,68例有诱发因素,其中有外伤史者27例,精神心理因素者28例。结论本地区白癜风男女发病比例相近,以青少年居多,寻常型最常见,好发于面颈部,外伤及精神心理因素为常见诱因,且有家族史患者病情较重。     

新生儿期发病的白癜风与遗传因素关系的探讨

[摘要] 目的 探讨遗传因素在新生儿期发病白癜风中的作用。方法 2002-2008年12月对我院白癜风专病门诊确诊的42例新生儿期（出生或出生几天后）即发现有白癜风的患者及其家系进行了详细的问卷调查与分析。结果 42例中男20例;女22例,有阳性家族史者17例占40.48%;在17例家系中,寻常型13例占30.95%、节段型4例占9.52%。一级、二级、三级、四级亲属患病率,分别为26.19%、33.33%、14.29%、11.90%。在家族连续几代发病中,其发病年龄逐渐提前,并可发生在相同年龄段和相似部位。结论 白癜风发病存在先天因素,提示遗传因素可能参与白癜风先天发病。     

白癜风患者血清中抗黑素细胞自身抗体与临床发病的关系

白癜风是一种黑素细胞被破坏的皮肤病。虽然发病的原因尚不明了,但资料表明黑素细胞的破坏与自身免疫有关。本研究利用黑素细胞培养技术,用改进的间接免疫荧光法测定白癜风患者血清中存在的抗黑素细胞抗体,以了解抗黑素细胞抗体在白癜风发病过程中的作用。一、资料和方法 (一)病例:白癜风患者病例的选择:均来自皮肤科门诊,其中男17例,女13例;病史最长26年,最短1个月,平均1.9年;皮损占体表面积最大者为90%,最小者为2%,50%以下者24例,50%以上者6例;有白癜风家族史7例,寻常型28例,节段型2例。半年内皮损明显发展者8例,为活动期患者,其余22例为静止期患者。     

Different phenotypes of segmental vitiligo based on a clinical observational study

Background Segmental vitiligo and generalized vitiligo are in general considered separate entities. However, clinico‐epidemiological data on segmental vitiligo are scarce compared with those of generalized vitiligo. Objective To analyse the clinical profile and distribution pattern of lesions in segmental vitiligo patients. Methods Segmental vitiligo patients were examined and questioned in a prospective and retrospective setting. The distribution and extent of the lesions were evaluated using clinical photographs. Results Different phenotypes of segmental vitiligo were found, including the unilateral segmental type (124 patients; group 1), the bilateral segmental type (three patients; group 2) and the mixed segmental and generalized type (14 patients; group 3). Furthermore, lesions were present with (10%) or without associated halo naevi. The age of onset of segmental vitiligo (median 14 years) was significantly different between the three subgroups (P = 0.028). Extensive involvement of segmental vitiligo lesions on trunk and extremities was significantly (P = 0.031) more observed in patients with a lower age of onset, while the generalized vitiligo lesions in the mixed vitiligo group were mostly very mild. Associated autoimmune diseases were reported in 11%, whereas a positive family history for vitiligo was present in 14.9% of patients. Lesions were not strictly dermatomal nor Blaschkolinear, although a typical recurring pattern could be observed. Conclusion Our data provide clinical evidence that segmental vitiligo and generalized vitiligo are parts of the same disease spectrum and that segmental vitiligo could have a polygenetic background as well. Whether different aetiopathological mechanisms underlie the different clinical phenotypes of segmental vitiligo remain to be elucidated.     

Difference in clinical features and HLA antigens between familial and non-familial vitiligo of non-segmental type

Of 131 patients with non-segmental vitiligo studied, 29 (22%) had a family history of this disorder. The clinical features and HLA antigens were assessed, and a comparison made between patients with familial and those with non-familial, non-segmental vitiligo. Familial patients developed skin lesions significantly earlier than non-familial patients. There was a significant association between HLA-B46 and familial non-segmental vitiligo, whereas HLA-A31 and CW4 were found in non-familial patients. The differences in clinical features and HLA phenotypes suggest heterogeneity in the pathogenic process between familial and non-familial vitiligo patients.     

Association of halo nevus/i and vitiligo in childhood: a retrospective observational study

Background Although halo nevus (HN) is frequently observed, the relationship between vitiligo and HN in children has rarely been investigated. Objectives To investigate the association between HN and vitiligo in children and understand if HN/HNi might be a risk factor for vitiligo. Methods Ninety‐eight patients with only HN/HNi and 27 with HN/HNi and vitiligo were investigated for number and localization of HN/HNi, family history for HN/HNi and vitiligo and personal and family history for autoimmune or other diseases. A follow‐up telephone interview was performed to investigate the evolution of HN/HNi and the possible onset of vitiligo and/or other diseases. Results In the HN/HNi and vitiligo group, HN/HNi and vitiligo had started almost simultaneously in 11 children; in nine, the onset of HN/HNi was followed by vitiligo after 6 months to 5 years; seven patients presented vitiligo first and HN/HNi after 3–9 years. Patients with associated vitiligo had, significantly more often, multiple HNi and a positive personal and/or family history of autoimmune thyroiditis compared with those with only HN/HNi. Follow‐up longer than 5 years was available in 54/98 patients with only HN/HNi; two of them, both with multiple HNi, developed vitiligo. After follow‐up, multiple HNi were noticed in 18/52 patients without vitiligo and in 9/11 of those in whom HN/HNi heralded vitiligo (s.s.). Conclusions In patients with multiple HNi, the risk of vitiligo and other autoimmune diseases seems to be higher than in pediatric patients with a single HN; clinicians should pay particular attention to children with multiple HNi and personal or family history of autoimmune diseases.     

Evaluation of the effects of NB-UVB in both segmental and non-segmental vitiligo affecting different body sites

BACKGROUND: Narrow band (NB)-UVB has been used in the treatment of vitiligo for years but statistical evaluation of the clinical response in both segmental and non-segmental vitiligo patients has yet to be assessed. OBJECTIVES: Statistical evaluation of the clinical response of vitiligo patients to NB-UVB in both segmental and non-segmental types affecting different body sites. METHODS: This study included 150 patients with vitiligo either segmental (10%) or non-segmental (90%). NB-UVB therapy was given twice weekly till reaching our end point of 100% re-pigmentation or a cut point in unresponsive cases. Evaluation of the percentage of re-pigmentation was performed by total body photography and planimetry every 8 weeks. RESULTS: The overall response to therapy in the non-segmental vitiligo group demonstrated that 48% of the patients showed marked response, 27% showed moderate response and 25% showed mild response after UVB therapy. The patients showed marked response in 76.3% in face lesions, 41.9% in trunk lesions and 37.6% in limbs lesions. None of the patients in the acral areas achieved marked response. The mean duration of therapy was 7.8 months. Moreover, the results demonstrated that the earlier the patient was treated, the better the response was especially for lesions on the face, trunk and limbs. On the other hand, in the segmental vitiligo group, patients showed no more than mild response to NB-UVB whatever the site of the lesion was. No side effects were encountered with NB-UVB therapy except for aggravation of the disease in two cases and erythema in one patient who was an outdoor worker and was skin type II. CONCLUSION: The type of vitiligo, the affected anatomical area and the disease duration are important factors that influence potential re-pigmentation.     

Autoantibodies against tyrosine hydroxylase in patients with non-segmental (generalised) vitiligo

Vitiligo is an acquired idiopathic hypomelanotic skin disorder characterised by depigmented macules because of loss of cutaneous melanocytes. Although the exact cause of vitiligo remains obscure, evidence suggests that autoimmunity plays a role in the pathogenesis of the disease. Previously, tyrosine hydroxylase (TH) was identified as a putative autoantigen in vitiligo using phage-display technology. In this study, the prevalence of TH antibodies in patients with vitiligo was investigated. A radioimmunoassay (RIA) was used to detect TH antibodies in sera from patients with either non-segmental vitiligo (n=79), segmental vitiligo (n=8) or other autoimmune diseases without concomitant vitiligo (n=91). Sera from healthy individuals (n=28) were also tested. Patients with segmental vitiligo, healthy controls and patients with other autoimmune diseases without concomitant vitiligo were all negative for TH antibody reactivity. Of 79 patients with non-segmental vitiligo, 18 (23%) were positive for TH antibodies in the RIA, and a significant increase in the prevalence of TH antibodies in patients with non-segmental vitiligo was evident when compared with controls (P=0.003). TH antibody prevalence was also significantly elevated in patients with active vitiligo compared to those with stable disease (P=0.009). Overall, the results indicate that TH is an antibody target in non-segmental but not in segmental vitiligo and that TH antibodies appear to be more frequent in patients with active vitiligo.     

Vitiligo is associated with HLA-DR4 in black patients. A preliminary report

We have determined the HLA-DR and HLA-DQ phenotypes of 24 black patients with vitiligo and compared these with phenotypes of 143 local black controls. HLA-DR4 was significantly increased in patients, 38% vs 11% for controls. HLA-DQw3 was also increased in patients, 58% vs 32% for controls and may be explained in part by linkage disequilibrium with HLA-DR4. When patients were subgrouped according to family history of autoimmune disease and compared with controls, the increase in HLA-DR4 and HLA-DQw3 segregated with a positive family history. HLA-DRw6 in patients with a negative family history of autoimmune disease (64%) was significantly greater than the 10% in patients with a positive family history. When patients were subgrouped according to age at onset of disease, HLA-DR4 was increased in those with early onset of disease (younger than 20 years) while HLA-DRw6 was greater in patients who were older at onset of disease. These findings support the hypothesis of an immunogenetic influence on the expression of vitiligo in black patients with vitiligo.     

Relevance of thyroiditis and of other autoimmune diseases in children with vitiligo

BACKGROUND: Studies that clearly define the possible association of childhood vitiligo with autoimmune and/or endocrine diseases are lacking. OBJECTIVE: To examine the presence of autoimmune disorders, in particular of thyroid disease, in paediatric patients with vitiligo and investigate the utility of such screening in these patients. METHODS: One hundred and twenty-one paediatric patients (40 males, 81 females) with vitiligo were grouped in segmental and non-segmental vitiligo. All patients were screened for thyroid disease. RESULTS: 13 out of 121 patients had different degrees of thyroid parameter alterations. These patients were all affected by the non-segmental type while none of those with the segmental form presented thyroid alterations. CONCLUSION: In paediatric patients with non-segmental vitiligo, a significant incidence of thyroid dysfunction was found. Since vitiligo usually appears before the development of the thyroid disease, it may be useful to screen thyroid autoantibodies in all paediatric patients with non-segmental vitiligo who present symptoms related to thyroid disease.     

The progression of nonsegmental vitiligo: clinical analysis of 318 patients

Background Vitiligo is an acquired disorder with destruction of melanocytes and is characterized by cutaneous depigmentation with a progressive clinical course. We attempted to evaluate whether there was a relationship between the initial site and ultimate progression of nonsegmental vitiligo. Methods Three hundred and eighteen nonsegmental vitiligo patients were examined. Questionnaires regarding age, sex, duration of disease, family history, distribution of initial lesions, progression, and clinical type were recorded from personal interviews and case notes. Results Two hundred and eighty nine (90.9%) of the 318 patients showed progression of vitiligo at the time of examination. When the initial sites were the posterior trunk, hands, or feet, there was more progression of vitiligo to other body areas. The progression pattern was usually contiguous to the initial site. When the hands were the initial site, however, vitiligo most commonly progressed to the face. Conclusions There may be a possible relationship between the initial site and ultimate progression of nonsegmental vitiligo. The progression pattern is usually contiguous to the initial site.