121例关节病型银屑病临床特征的相关研究

发布时间：2018-05-04 00:05

本文选题：关节病型银屑病 + 银屑病性关节炎PsA　；参考：《安徽医科大学》2017年硕士论文

【摘要】：研究背景和目的关节病型银屑病亦称银屑病性关节炎(Psoriatic arthritis,PsA),属于脊柱关节病(spondyloarthropathy,SpA)的一个亚型。PsA是一种临床异质性较强的系统性、免疫性、炎症性疾病,临床表现复杂多样,包括一组炎症性改变:如银屑病红斑鳞屑皮损、指(趾)甲病变、关节滑膜炎、附着点炎、溃疡性结肠炎、虹膜睫状体炎等。PsA以银屑病皮损和关节炎症为主要临床特征,皮损可表现为寻常型、红皮病型、脓疱型,其关节损伤常导致关节及其周围软组织疼痛、肿胀,僵硬、运动障碍,病程迁延、反复发作,甚至呈进行性加重,出现关节永久性损伤而残毁,严重影响了患者的社会交往和生活质量,给患者造成极大的心身痛苦。本研究通过分析Ps A的临床特征及实验室指标变化的意义,加深对PsA病因病机的认识,为制定出符合中国国情的PsA分型分级标准提供理论依据,同时为有效防治PsA及其系统损害、改善其预后等积累经验。方法根据PsA的CASPAR诊断标准筛选2013年7月至2015年12月于空军总医院皮肤科就诊的121例PsA患者,对其基线时病史、体格检查及相关实验室检查的资料进行统计分析,并与58例寻常型银屑病患者和70例正常健康者进行对照。利用SPSS17.0统计软件,计量资料的比较采用t检验、单因素方差分析、LSD法、Kruskal-Wallis检验、Wilcoxon符号秩和检验,计数资料的比较采用c2检验,指标间相关性采用Spearman相关性分析法。结果1、发病情况:121例PsA患者,男69例,女52例,男女之比为1.33:1,平均年龄(41.29±12.42)岁。银屑病皮损初发病年龄平均(27.51±11.95)岁,关节炎初发病年龄平均(36.70±11.95)岁。以皮损首发者100例(82.64%),以关节炎首发者6例(4.96%),皮损和关节炎同时出现者15例(12.40%)。2、psa皮肤损害:(1)皮损分型:皮损为寻常型者112例(92.56%),脓疱型者5例(4.13%),红皮病型者4例(3.31%);(2)皮损分期:进展期者89例(73.55%),静止期者21例(17.36%),消退期者11例(9.10%);(3)皮损严重程度:pasi评分0.30~50.10分,平均11.80(13.30)分。轻度者(0pasi10)51例(42.15%),中度者(10≤pasi30)60例(49.59%),重度者(pasi≥309例(7.44%)。3、psa关节损伤:(1)外周型101例(83.47%),累及的关节中以手部第Ⅲ指近端指间关节受累最为多见;中轴型20例(16.53%),最常累及足部第Ⅲ趾近端趾间关节。(2)单纯附着点炎8例(6.61%),最常累及足跟;单纯滑膜炎15例(12.40%),最常累及膝关节;附着点炎合并滑膜炎98例(80.99%),最易累及手近端指间关节,并以第Ⅲ指近端指间关节受累最为常见。4、psa皮肤与关节损害的关系:外周型和中轴型psa在银屑病皮损分型上差异有高度统计学意义(p=0.001),而在皮损分期(p=0.608)方面无差异。中轴型psa患者中,脓疱型和红皮病型发生率高于外周型。5、系统损害特征:psa易合并尿酸、糖、脂代谢和造血系统功能异常,且后两者异常特点与pv不同。(1)尿酸水平:psa患者ua明显高于正常,差异有统计学意义(p0.05);(2)糖代谢:psa患者fbs明显高于正常及寻常型,差异均有统计学意义(p0.05);(3)脂代谢:psa患者tg、apoaⅠ、apob100明显升高,差异均有统计学意义(p0.05);hdl-c明显下降,差异亦有高度统计学意义(p=0.000)。pv患者tc、ldl-c、hdl-c、apob100明显下降,差异有统计学意义(p0.05)。(4)造血系统功能:psa患者rdw明显下降,差异有高度统计学意义(p=0.000);mcv、mch、mchc与正常对照相比无差异(p0.05)。pv患者rdw明显下降,mcv、mch、mchc明显升高,差异均有高度统计学意义(p=0.000)。psa患者plt明显高于正常对照及寻常型,差异均有高度统计学意义(p=0.000);mpv明显低于正常,但较寻常型高,差异均有统计学意义(p0.05)。psa患者wbc、neut明显高于正常及寻常型,差异均有高度统计学意义(p0.01)。6、psa病情评估指标:(1)psa皮损评估指标:esr(r=0.19,p=0.045)、crp(r=0.251,p=0.007)和hs-crp(r=0.247,p=0.049)三项炎症性指标与psa患者皮损的pasi评分均呈正相关,ua与pasi评分亦呈正相关(r=0.217,p=0.018);(2)psa关节损伤评估指标:il-6与压痛关节数(r=0.314,p=0.001)、压痛关节评分(r=0.332,p=0.001)、肿胀关节数(r=0.264,p=0.006)和肿胀关节评分(r=0.292,p=0.003)等均呈正相关,hs-crp与压痛关节数(r=0.391,p=0.002)、压痛关节评分(r=0.403,p=0.001)、肿胀关节数(r=0.225,p=0.078)和肿胀关节评分(r=0.212,p=0.098)等均呈正相关,crp与压痛关节数(r=0.287,p=0.002)、压痛关节评分(r=0.260,p=0.006)、肿胀关节数(r=0.196,p=0.040)等均呈正相关,hdl-c与关节压痛程度呈负相关(压痛关节数:r=-0.232,p=0.014;压痛关节评分:r=-0.218,p=0.021)。小结(1)大多数psa患者的银屑病皮损先于关节损伤出现,且皮损分型以寻常型为主,皮损分期以进展期主,皮损严重程度以轻、中度为主;(2)psa的关节损伤主要累及外周动关节,以附着点炎合并滑膜炎为主,最常累及近端指间关节;(3)中轴型psa患者中,脓疱型和红皮病型发生率高于外周型;(4)psa易合并尿酸、糖、脂等代谢异常,且后两者异常特点与pv不同。psa患者ua明显高于正常,但低于寻常型,psa患者fbs明显高于正常及寻常型。psa患者tg、apoaⅠ、apob100明显升高,hdl-c明显下降;(5)psa易伴发造血系统功能异常,psa合并的贫血类型为正细胞均一性贫血;psa外周血中plt、wbc、neut明显升高,mpv明显减小;(6)esr、crp和hs-crp三项炎症性指标和尿酸水平可在一定程度上反映psa患者皮损炎症活动程度;(7)IL-6、hs-CRP、CRP和HDL-C可作为评估PsA关节炎症活动度的参考指标。深入了解PsA的临床特征和实验室指标变化的临床意义,对于PsA的早期诊断、评估以及规范化防治具有重要指导意义。
[Abstract]:Background and objective psoriasis, also known as Psoriatic arthritis (PsA), is a subtype of spondyloarthropathy (spondyloarthropathy, SpA), a subtype of.PsA that is a highly heterogeneous, systemic, immune, inflammatory disease with complex clinical manifestations, including a group of inflammatory changes, such as psoriasis red Skin lesions, finger (toe) lesions, joint synovitis, attachment point inflammation, ulcerative colitis, iritis and ciliary body inflammation are the main clinical features of psoriasis and joint inflammation. The skin lesions can be characterized by vulgaris, erythrodermic, pustular, and joint injuries often causing pain, swelling, stiffness, and dyskinesia in the joints and their surrounding soft tissues. The course of the disease was prolonged, repeated attacks, even progressive aggravation, and the permanent injury of the joints was damaged and damaged, which seriously affected the social communication and quality of life of the patients, and caused great mental and physical pain for the patients. This study was made through the analysis of the clinical features of Ps A and the significance of the changes in the laboratory indexes to deepen the understanding of the etiology and pathogenesis of PsA. In accordance with the national conditions of China, the PsA classification and classification standards provide the theoretical basis, at the same time, to effectively prevent and control PsA and its systemic damage and improve its prognosis. Methods according to the CASPAR diagnostic criteria of PsA, 121 cases of PsA patients who were diagnosed in Department of Dermatology of General Hospital of the Air Force PLA from July 2013 to December 2015 were selected. The data of laboratory examination were statistically analyzed and compared with 58 cases of psoriasis vulgaris and 70 normal healthy persons. Using SPSS17.0 statistical software, the comparison of measurement data was compared with t test, single factor variance analysis, LSD method, Kruskal-Wallis test, Wilcoxon sign rank sum test, and comparison of count data using C2 test and index. Correlation used Spearman correlation analysis. Results 1, incidence of disease: 121 cases of PsA patients, 69 men and 52 women, the ratio of men and women was 1.33:1, the average age was (41.29 + 12.42) years old. The average age of onset of psoriasis was (27.51 + 11.95) years (27.51 + 11.95) years, and the average age of arthritis was (36.70 + 11.95) years old. The first onset of skin lesions was 100 (82.64%), with arthritis first first. 6 cases (4.96%), skin lesions and arthritis in 15 cases (12.40%).2, PSA skin damage: (1) skin lesions of 112 cases (92.56%), 5 cases of pustular type (4.13%), 4 cases of red skin type, 4 cases (3.31%); (2) stage of lesion, 89 cases (73.55%), stationary phase Degree: PASI score 0.30~50.10 score, average 11.80 (13.30) points. Mild (0pasi10) 51 cases (42.15%), moderate (10 < pasi30) 60 cases (49.59%), severe (PASI > 309 cases (7.44%).3, PSA joint damage: (1) peripheral 101 cases (83.47%), involved in the third finger proximal interphalangeal joint involvement in the most common; middle axis 20 cases (16.53%), the most often tired. The interphalangeal joint of the third toe of the foot. (2) 8 cases of simple attachment point inflammation (6.61%), the most often involved in the heel; 15 cases of simple synovitis (12.40%), the most often tiring and knee joint; adherent point inflammation and 98 cases (80.99%), the most likely to involve the proximal interphalangeal joint of the hand, and the most common.4, PSA skin and joint damage with the proximal interphalangeal joints of the third finger. The difference in psoriatic skin lesions was highly statistically significant (p=0.001) in peripheral and middle type PSA (p=0.001), but there was no difference in skin lesion staging (p=0.608). The incidence of pustular and erythroderma type was higher than that of peripheral.5 in patients with middle axis type PSA. The characteristics of systemic damage were: PSA was easy to combine with uric acid, sugar, lipid metabolism and hematopoietic system dysfunction, and two The abnormal characteristics were different from that of PV. (1) uric acid level: PSA patient UA was significantly higher than normal, the difference was statistically significant (P0.05); (2) glucose metabolism: PSA patients were significantly higher than normal and normal type, the difference was statistically significant (P0.05); (3) lipid metabolism: TG, ApoA I, apoB100 significantly increased in PSA patients, the difference was statistically significant (P0.05); obviously lower The difference also had a high statistical significance (p=0.000).Pv patients TC, LDL-C, HDL-C, apoB100 significantly decreased, the difference was statistically significant (P0.05). (4) the function of the hematopoietic system: RDW decreased significantly in PSA patients, and the difference was statistically significant (p=0.000); MCV, MCH, and normal The difference both showed high statistical significance (p=0.000).Psa patients PLT was significantly higher than normal control and normal type, the difference was statistically significant (p=0.000), MPV was significantly lower than normal, but higher than normal, the difference was statistically significant (P0.05).Psa patients WBC, neut significantly higher than normal and vulgaris, the difference was highly statistically significant (P0.01).6, PSA evaluation index: (1) the index of PSA skin lesion assessment: ESR (r=0.19, p=0.045), CRP (r=0.251, p=0.007) and hs-CRP (r=0.247, and hs-CRP) were positively correlated with the severity score of the patients' skin lesions. .314, p=0.001), r=0.332 (p=0.001), swelling joint number (r=0.264, p=0.006) and swelling joint score (r=0.292, p=0.003) were all positive correlation, hs-CRP and pressure joint number (r=0.391, p=0.002), pain joint score, swelling joint score, swelling joint score and so on are all positive CRP was correlated with the number of r=0.287 (p=0.002), r=0.260 (p=0.002), r=0.260 (p=0.006), the number of swelling joints (r=0.196, p=0.040) and so on. HDL-C had a negative correlation with the degree of joint pressure pain (the number of pain joints: r=-0.232, p=0.014; r=-0.218, p=0.021). (1) most of the patients with psoriasis were prior to the joints. The damage occurred, and the lesions were mainly typed in the ordinary type, the lesions were mainly in the progressive stage, and the severity of the lesions was mainly mild and moderate; (2) the joint injury of PSA was mainly involved in the peripheral joints, mainly with adherent point inflammation and synovitis, and most often involved the proximal interphalangeal joints; (3) the incidence of pustular and erythroderma type in the middle axis type PSA patients was higher than that of the outside. (4) PSA was easy to merge with uric acid, sugar, fat and other metabolic abnormalities, and the abnormal characteristics of the latter two were significantly higher than that of normal PV in.Psa patients, but the FBS in PSA patients was significantly higher than that of normal and normal.Psa patients TG, ApoA I, apoB100 significantly increased, HDL-C obviously decreased; (5) anemia associated with the anemia of the combined anemia class. The PLT, WBC, neut and MPV decreased obviously in the peripheral blood of PSA; (6) the three inflammatory indices and uric acid levels of ESR, CRP and hs-CRP can reflect the degree of inflammatory activity in patients with PSA; (7) IL-6, hs-CRP, CRP, and may be used as a reference for evaluating the degree of inflammatory activity. The clinical significance and clinical significance of changes in laboratory parameters are of great significance for early diagnosis, evaluation and standardized prevention and treatment of PsA.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R758.63

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