Association of Clinical Markers With Disease Progression in Patients With Vitiligo From China
Association of Clinical Markers With Disease Progression in Patients With Vitiligo From China
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中国白癜风患者临床标志物与疾病进展的关联
DOI：
10.1001/jamadermatol.2019.4483
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发表时间：
2020-03-01
期刊：
影响因子：
10.9
通讯作者：
Xiang, Leihong
中科院分区：
文献类型：
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作者：
Zhang, Li;Chen, Shujun;Xiang, Leihong
问题白癜风的临床标志物可以用来评估疾病进展、严重程度和患者预后吗？在这项队列研究中，来自中国的458例白癜风患者中，425例完成12个月随访的患者中，224例（52.7%）没有任何临床标志物，201例（47.3%）在首次访视时至少有1个临床标志物。基线检查和3个月随访时，有临床标志物的队列中活动期患者比例显著高于无任何标志物的队列;临床标志物的存在也与1个月和3个月随访时的疾病进展相关。意义该发现表明，临床标志物，包括三色征、五彩纸屑样色素脱失和Koebner现象，与白癜风的进展和预后有关，具有多种临床标志物的患者可能需要更强化的治疗。这项队列研究评估了白癜风的临床标志物，如三色征，五彩纸屑样色素脱失和Koebner现象，在评估疾病进展，严重程度，重要性有必要确定白癜风的临床标志物是否与疾病进展、严重程度和患者预后相关。目的探讨三色征、五彩纸屑样色素脱失和Koebner现象在评估白癜风病情进展、严重程度和预后中的价值。设计、设置和参与者在这项前瞻性队列研究中，从2016年9月1日至2019年5月13日在中国上海复旦大学华山医院门诊招募了425名白癜风患者。主要结果和测量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白癜风欧洲工作组扩散评分至少有1个或多个病变表现为黑色素减少，使用Wood光边界不清楚。使用白癜风面积评分指数（VASI）和血清CXCL 10水平测量评估进展。结果在458名入组患者中，425名（235名女性[55.3%];平均[SD]年龄，30.9 [10.2]岁）完成了12个月的随访。在425名患者中（224例无临床标志物，201例至少有1种临床标志物），与首次访视时无任何临床标志物的队列相比，至少有1种临床标志物的队列中疾病活动期的比例显著较高（196/201 [97.5%] vs 159/224 [71.0%]; P < .001）和3个月随访时（91/201 [45.3%] vs 52/224 [23.2%]; P < .001）。在1个月随访时（201例中142例[70.6%] vs 224例中60例[26.8%]; P <0.001）和3个月随访时（201例中63例[31.3%] vs 224例中9例[4.0%]; P <0.001），至少有1种临床标志物的患者中疾病快速进展的患者比例也较高。在6个月时，与没有任何临床标志物的患者相比，具有至少1种临床标志物的患者的VASI评分（SD）改善显著较小（平均值[SD]，0.14 [0.12] vs 0.23 [0.21]; P = .02），9个月时（平均值[SD]，0.29 [0.19] vs 0.44 [0.25]; P = 0.03）和12个月时（平均值[SD]，0.47 [0.21] vs 0.63 [0.23]; P = 0.03）。结论和相关性白癜风患者临床标志物的存在可能与预后差和疾病进展快有关。具有多种临床标志物的患者可能需要更强化的治疗。
Question Can the clinical markers of vitiligo be used to assess disease progression, severity, and patient prognosis? Findings In this cohort study of 458 patients with vitiligo from China, among 425 patients who completed 12-month follow-up, 224 (52.7%) did not have any clinical marker and 201 (47.3%) had at least 1 clinical marker at the first visit. The proportion of patients in the active stage was significantly higher in the cohort with clinical markers compared with the cohort without any marker at the baseline examination and at 3-month follow-up; presence of clinical markers was also associated with disease progression at 1- and 3-month follow-up Meaning The findings suggest that clinical markers, including trichrome sign, confetti-like depigmentation, and Koebner phenomenon, are associated with vitiligo progression and prognosis and that patients with multiple clinical markers may require more intensive treatment.This cohort study evaluates the utility of clinical markers of vitiligo, such as trichrome sign, confetti-like depigmentation, and Koebner phenomenon, in assessing disease progression, severity, and prognosis in patients from China.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.