【摘要】 目的 探讨肢端白癜风不同解剖部位的治疗反应及复色模式，分析影响疗效的潜在因素。方法 回顾性分析2022年12月至2025年1月在复旦大学附属华山医院皮肤科就诊的288例肢端白癜风患者的临床资料。将肢端划分为4个解剖区域：肢端背部(手背、足背)、肢端近端(手指、足趾近端指节)、肢端远端(手指、足趾中远端指节)和掌跖部(手掌、足底)。记录各区域白斑分布情况，采用白癜风面积评分指数(VASI)评估治疗前及治疗12个月后的皮损严重程度，并计算VASI改善率，观察复色模式。采用线性混合效应模型进行疗效比较及相关因素分析，以患者ID为随机截距项校正个体内相关性。结果 288例患者中男182例(63.19%),女106例(36.81%),平均发病年龄(25.67±13.21)岁，病程中位数为6.13(2.00,10.00)年。各区域受累患者数分别为：肢端背部187例(64.93%)、肢端近端156例(54.17%)、肢端远端203例(70.49%)、掌跖部98例(34.03%),其中207例(71.88%)患者同时累及2个及以上区域。治疗12个月后，基于线性混合效应模型，各区域估计边际VASI改善率分别为：肢端背部平均(44.32±1.58)%、肢端近端平均(39.67±1.72)%、掌跖部平均(23.54±2.04)%、肢端远端平均(19.87±1.46)%,整体比较差异有统计学意义(F=15.623,P<0.001)。进一步两两比较显示，肢端背部与近端差异无统计学意义(P=0.142),二者VASI改善率均高于掌跖部和远端(P<0.001),掌跖部与远端差异无统计学意义(P=0.458)。复色模式方面，肢端背部和近端以毛囊周围型为主(62.37%、58.44%),而掌跖部和远端以弥漫型复色为主(53.06%、61.58%)。多因素线性混合效应模型分析显示，在校正病程、基线体表受累面积(BSA)、年龄、性别、发病年龄、临床分期、是否接受系统治疗及是否接受光疗后，解剖部位(肢端背部vs.远端：β=24.45,95%CI:20.16～28.74,P<0.001)、病程(β=-0.85,95%CI:-1.26～-0.44,P<0.001)和基线BSA(β=-1.12,95%CI:-1.87～-0.37,P=0.003)与VASI改善率均存在统计学关联，而年龄、性别、发病年龄、临床分期及治疗方式等与VASI改善率未见统计学关联(P>0.05)。结论 肢端白癜风不同解剖部位的治疗反应及复色模式存在一定差异，其中肢端背部和近端部位的改善相对较好，掌跖部和远端部位改善相对有限。解剖部位、病程及基线BSA与VASI改善率相关，可为肢端白癜风疗效预期评估和区域分层治疗研究提供参考。更多还原

【Abstract】 Objective To investigate the treatment response and repigmentation patterns across different anatomical sites in acral vitiligo and to analyze potential factors influencing therapeutic outcomes. Methods A retrospective analysis was conducted on 288 patients with acral vitiligo who attended the Department of Dermatology, Huashan Hospital between December 2022 and January 2025. Acral regions were categorized into dorsal(dorsum of hands and feet), proximal(proximal phalanges of fingers and toes), distal(middle and distal phalanges), and palmar/plantar(palms and soles). The distribution of lesions in each region was recorded. The vitiligo area scoring index(VASI) was used to assess lesion status before treatment and after 12 months of therapy. Repigmentation patterns were also evaluated. For data with nested structure from lesions involving multiple anatomical regions, a linear mixed-effects model was employed for efficacy comparisons and analysis of associated factors, with patient ID included as a random intercept to account for within-individual correlation. Results Among the 288 patients, 182 were male(63.19%) and 106 were female(36.81%), with a mean onset age of 25.67±13.21 years. The number of patients with involvement in each region was as follows: dorsal, 187(64.93%); proximal, 156(54.17%); distal, 203(70.49%); and palmar/plantar, 98(34.03%). A total of 207 patients(71.88%) showed involvement in two or more regions. After 12 months of treatment, the linear mixed-effects model estimated the marginal mean VASI improvement rates(mean±standard error) as follows: dorsal,(44.32±1.58)%, proximal,(39.67±1.72)%, palmar/plantar,(23.54±2.04)%, and distal,(19.87±1.46)%; with a statistically significant overall difference(F=15.623, P<0.001). Pairwise comparisons showed no significant difference between dorsal and proximal regions(P=0.142), both of which demonstrated superior outcomes compared with palmar/plantar and distal regions(P<0.001). No significant difference was observed between palmar/plantar and distal regions(P=0.458). Regarding repigmentation patterns, perifollicular repigmentation predominated in dorsal and proximal regions(62.37% and 58.44%, respectively), whereas diffuse repigmentation was more common in palmar/plantar and distal regions(53.06% and 61.58%, respectively). Multivariable linear mixed-effects model analysis showed that, after adjusting for disease duration, baseline BSA, age, sex, age at onset, clinical stage, systemic treatment and phototherapy, three variables, including anatomical region(dorsal vs. distal: β=24.45, 95% CI: 20.16 to 28.74, P<0.001), disease duration(β=-0.85, 95% CI:-1.26 to-0.44, P<0.001), and baseline body surface area(BSA)(β=-1.12, 95% CI:-1.87 to-0.37, P=0.003), were statistically associated with VASI improvement, whereas age, sex, and age at onset were not(P>0.05). Conclusion Treatment response and repigmentation patterns may vary across anatomical regions in patients with acral vitiligo, with relatively greater improvement observed in dorsal and proximal regions, and limited improvement in palmar/plantar and distal regions. Anatomical region, disease duration, and baseline BSA were associated with VASI improvement, and may provide a reference for evaluating treatment response and informing region-specific stratified approaches in acral vitiligo.更多还原