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。

Therapeutic efficacy and safety of cultured autologous melanocyte transplantation for patients with non-segmental vitiligo complicated by autoimmune thyroid diseases: a clinical observation and long-term follow-up

【Abstract】 Objective To investigate clinical efficacy and safety of cultured autologous melanocyte transplantation for the treatment of non-segmental vitiligo accompanied by autoimmune thyroid diseases. Methods From May 2008 to December 2018, a total of 2 284 patients with non-segmental vitiligo were retrospectively collected, who received cultured autologous melanocyte transplantation in Hangzhou Third People′s Hospital. Among these patients, 75 were also diagnosed with autoimmune thyroid diseases, including hyperthyroidism （42 cases）, hypothyroidism （18 cases） and Hashimoto′s thyroiditis （15 cases）. Efficacy and safety were compared between the vitiligo patients with autoimmune thyroid diseases （concomitant group） and those without （non-concomitant group）. Chi-square test was used to compare enumeration data. Results Among the 2 284 patients, 1 085 were males and 1 199 were females, with an age of 25.0 ± 1.2 years and a disease duration of 5.1 ± 2.3 years. Six months after transplantation, 1 873 out of 2 209 patients in the non-concomitant group achieved favorable clinical response, with a response rate of 84.8%, including 1 162 achieving complete clinical response （52.6%）; 46 out of 75 patients in the concomitant group achieved favorable clinical response, with a response rate of 61.3%, including 20 achieving complete clinical response （26.7%）; the response rate and recovery rate were both significantly lower in the concomitant group than in the non-concomitant group （χ2 = 29.72, 19.54, respectively, both P < 0.001）. Moreover, the response rate was significantly lower in the hypothyroidism group than in the hyperthyroidism group （χ2 = 6.61, P = 0.010）. The incidence of isomorphic response at the donor site was significantly higher in the concomitant group than in the non-concomitant group （9.3% vs. 4.3%, χ2 = 4.31, P = 0.038）, so were the recurrence rates of vitiliginous patches at the recipient site after 1, 3, 5 and 10 years （concomitant group: 6.7%, 14.7%, 17.3%, 8.7%, respectively; non-concomitant group: 0.7%, 1.4%, 2.1%, 3.6%, respectively; χ2 = 29.96, 70.69, 67.23, 41.61, respectively, all P < 0.001）. Conclusion Concomitant autoimmune thyroid diseases negatively affect the efficacy of cultured autologous melanocyte transplantation in the treatment of vitiligo, so effective measures should be taken to prevent isomorphic response and recurrence at the recipient site for patients with non-segmental vitiligo complicated by autoimmune thyroid diseases.