中国东北地区汉族人群中寻常型银屑病分型研究

发布时间：2018-03-18 14:06

本文选题：汉族　切入点：寻常型银屑病　出处：《大连医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：银屑病是一种反复发作性慢性炎症性皮肤病，迄今为止被认为是一种单一的疾病。但是，最近的研究显示早发型银屑病与晚发型银屑病在病理生理上和治疗愈后上存在差异，也就提示了银屑病间存在不同亚型。基于这种假设，几年前法国的皮肤科医师通过问卷调查的方式收集了大量的银屑病患者的资料，这些资料包括银屑病的主要临床特征的综合信息。再通过因素分析法、群集分析法和判别函数等统计学方法进行分类，最终成功的将1484名银屑病患者分成了6个临床亚型。这项研究为重点研究同质组患者的遗传学、遗传药理学、病理生理学和治疗学方面开辟了新的道路。关于本次研究的目的是验证此种方法是否同样适用于中国汉族人群中的寻常型银屑病患者。方法：本次研究采用了前瞻性流行病学研究方法，我们根据研究目的设计了特定的问卷以收集患者资料，本次研究共收集了中国东北地区的455例寻常型银屑病患者的临床特征资料。然后采用逐步聚类分析方法对患者进行分析。结果：最终将这455例患者分成了5个亚型组：第一型：共40人，占总样本量的8.8%，本组患者以男性为主；发病较晚，多在30至50岁之间发病；首次发病皮损多为点滴型；病程进展多为间断性；大多数患者无银屑病家族史；同形反应明显；病情严重程度受季节变化影响较大；病情最严重时皮肤受累面积较大。相对于其它部位躯干受累更明显。第二型：共72人，占总样本量的15.8%，患者间无明显性别差别；发病较早，多30岁以前发病；首次发病以点滴型皮损或钱币状皮损为主，且两者之间无明显差别。第三型：共70人，占总样本量的15.4%，患者间无明显性别差别；发病较晚，，多在30至50岁之间发病；首次发病可为点滴型皮疹或钱币状皮疹，以点滴型为主；多有银屑病家族史；病情最严重时皮肤受累面积较小。第四型：共29人，占总样本量的6.4%，患者间无明显性别差别；任何年龄都可发病但以多在30至50岁之间发病为主；首次发病时皮疹为大斑块样或钱币状；无银屑病家族史；同形反应不明显；病情变化受季节影响不明显。第五型：共244人，为样本量最大的一组，占总样本量的53.6%，本型患者无明显性别差异；发病年龄较早，多在30岁之前发病；首次发病可为点滴型皮疹或钱币状皮疹，以点滴型为主；有银屑病家族史；病情严重程度受季节变化影响较大；病情最严重时皮肤受累面积较小。结论：本研究提示依据寻常型银屑病的临床特征通过逐步聚类分析法对其分型同样适用于中国汉族局部区域的人群，通过此类方法所分得亚型之间可能存在遗传学和病理生理学的差异，同时在临床治疗方面起到一定的提示作用。
[Abstract]:Objective: psoriasis is a recurrent chronic inflammatory dermatosis that has been considered to be a single disease. Recent studies have shown differences in pathophysiological and therapeutic outcomes between early and late psoriasis, suggesting different subtypes of psoriasis. A few years ago, French dermatologists collected a large number of data on psoriasis patients through questionnaires, including comprehensive information on the main clinical characteristics of psoriasis. Statistical methods such as cluster analysis and discriminant function were used to classify 1484 psoriasis patients into 6 clinical subtypes. Pathophysiology and therapeutics have opened up a new path. The aim of this study is to verify whether the same method is applicable to psoriasis vulgaris in Chinese Han population. Methods: a prospective epidemiological study was used in this study. We designed a specific questionnaire to collect patient data according to the objective of the study. The clinical data of 455 patients with psoriasis vulgaris in Northeast China were collected in this study. Results: the 455 patients were divided into 5 subgroups:. Type I: 40 patients, who accounted for 8.8% of the total sample size. The patients were mainly male; the patients were late onset, most of them were between 30 and 50 years old; the first onset of skin lesions were mostly drip type; the course of disease was mostly intermittent; most of the patients had no family history of psoriasis, the majority of the patients had no family history of psoriasis, and most of the patients had no family history of psoriasis. The isomorphic reaction was obvious; the severity of the disease was affected by seasonal changes; the skin involvement area was larger when the disease was most serious, and the involvement was more obvious than that in other parts of the trunk. Type 2: 72 people, There was no significant gender difference among the patients; the onset was earlier, more than 30 years old; the first onset was mainly of drip-down or coin-like lesions, and there was no significant difference between the two. Type III: a total of 70 people, 15.4% of the total samples, there was no significant gender difference among the patients; the onset of the disease was late, mostly between 30 and 50 years old; the first onset could be a drip rash or a coin-like rash, mainly a drip type; most of them had a family history of psoriasis. The area of skin involvement was small when the disease was most serious. Type 4th: 29 people were involved, which accounted for 6.4% of the total sample size, and there was no significant gender difference between the patients, but most of them were from 30 to 50 years old. At the first onset, the rash was large plaques or coins; there was no family history of psoriasis; homotypic reactions were not obvious; changes in the disease were not significantly affected by seasons. Type 5th: a total of 244 people, the largest sample group, There was no significant gender difference in the patients with this type, the onset was earlier than the age before 30 years of age, the first onset could be a drip-type rash or a coin-like rash, mainly a drip type, with a family history of psoriasis. The severity of the disease was affected by seasonal changes, and the area of skin involvement was small when the disease was most serious. Conclusion: according to the clinical characteristics of psoriasis vulgaris, the classification of psoriasis vulgaris by stepwise cluster analysis is also applicable to the local population of Han nationality in China. There may be genetic and pathophysiological differences among the subtypes obtained by this method, and they may also play a role in clinical therapy.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R758.63

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