450例慢性荨麻疹临床流行病学调查

发布时间：2018-05-22 15:43

本文选题：慢性荨麻疹 + 临床流行病学　；参考：《昆明医科大学》2013年硕士论文

【摘要】：[目的]本研究通过对2010.5-2013.2来我科确诊为慢性荨麻疹的患者进行流行病学调查,以了解慢性荨麻疹临床流行病学特征。 [方法]调查问卷来自中国医师协会皮肤科医师分会全国荨麻疹调查CAUSE项目(如附件1)。选择符合入选标准的450例慢性荨麻疹患者,并由经过专门培训的医生询问情况并填写问卷调查表。内容包括：基本情况、初发年龄、病程、诱因、临床类型、瘙痒程度、发作时间、血管性水肿、UAS、家族过敏性疾病史、个人疾病史及既往治疗史等。采用Excel及SPSS17.0对数据进行录入分析,包括非参数统计、描述性分析、x2检验、秩和检验等。(P0.05为存在统计学差异。) [结果]450例患者中,男女之比为1：1.85,患者发病年龄为0.5-74岁,平均(32.3±14.1)岁,约1/2患者在21-40岁之间初次发病。病程2月-59年,病程在10年以上,占7.8%。诱发或加重因素：无明显诱因215例(47.8%),物理因素114例(25.3%),食物因素54例(12.0%),药物因素28例(6.2%),精神因素22例(4.9%),吸入性过敏原诱发18例(4.0%),剧烈运动诱发10例(2.2%),胃肠道不适诱发9例(2.0%)。42.9%患者有不同程度睡眠障碍,10.0%患者精神状态受到影响。 35.6%的患者有家族过敏性疾病史,分别为：荨麻疹87例(19.3%),过敏性鼻炎54例(12.0%),哮喘19例(4.2%),特应性皮炎6例(1.3%),接触性皮炎4例(0.9%),过敏性结膜炎1例(0.2%)。慢性感染性疾病是CU常见的伴发病,其中以Hp感染相关的慢性胃炎/消化性溃疡最常见为121例(26.9%),其次是扁桃腺炎/咽炎77例(17.1%),甲状腺疾病34例(7.6%)。临床分型中,以慢性自发性荨麻疹最常见294例(65.3%)；其次为物理性荨麻疹104例(23.1%),而物理性荨麻疹中,又以皮肤划痕症最常见70例(15.6%),慢性自发性荨麻疹合并皮肤划痕症47例(10.4%)。约1/3的患者即有风团又伴有血管性水肿,有血管性水肿的患者其瘙痒程度要比无血管性水肿的患者严重,且有血管性水肿的患者风团严重程度亦有加重趋势,风团持续时间有所延长。慢性荨麻疹发病具有一定的昼夜节律变化,51.3%患者于夜间发病或病情加重,而大多数慢性荨麻疹患者发病无明显季节性。 411例使用抗组胺药物的患者中,仅少部分患者对抗组胺药物治疗抵抗,仍觉中重度瘙痒；而超过90%的患者服药后可以明显控制症状(服药后无瘙痒占72.3%；轻度瘙痒占21.4%)。约1/5的患者既往曾系统使用了糖皮质激素,其中有5例仅单独使用该药,不加任何H1抗组胺药物。有169例患者行甲状腺自身抗体及功能检测,115例患者结果示正常,57例患者出现异常。TGAb、TMAb阳性率为21.3%,在慢性荨麻疹患者中甲状腺自身抗体、功能异常的患者UAS评分比正常者更高。 [结论]1.任何年龄人群均可发生慢性荨麻疹,女性发病明显多于男性,21-40岁人群受累最多。慢性荨麻疹病程长短不一,病程长达5年以上的患者占17.6%。 2.慢性荨麻疹患者最常见的伴发病是慢性胃炎及消化性溃疡、扁桃腺炎／咽炎,提示我们Hp及链球菌感染可能与慢性荨麻疹的发病存在一定关联,有待进一步研究。部分慢性荨麻疹与自身免疫性甲状腺疾病有密切关系,甲状腺自身抗体、功能异常的患者UAS评分更高。 3.慢性荨麻疹的临床分型中以慢性自发性荨麻疹最常见,物理性荨麻疹中又以皮肤划痕症最为常见,皮肤划痕症可并慢性自发性荨麻疹同时存在。约1/3的CU患者既有风团又伴有血管性水肿,有血管性水肿的患者其瘙痒程度要比无血管性水肿的患者更为严重,而且有血管性水肿的患者风团严重程度亦有加重趋势,风团持续时间有所延长。
[Abstract]:[Objective] to investigate the clinical epidemiological characteristics of chronic urticaria by an epidemiological survey of patients with chronic urticaria confirmed by 2010.5-2013.2 in our department.
[Methods] the questionnaire came from the CAUSE project of the national urticaria Survey (Annex 1) of the Chinese Medical Doctor Association Department of dermatologists (such as Annex 1). 450 patients with chronic urticaria were selected in accordance with the criteria of admission and were asked by a trained doctor and filled out the questionnaire. The contents include the basic situation, the initial age, the course of the disease, the inducement, the clinical class. Type, itching, seizure time, vascular edema, UAS, family history of anaphylaxis, history of personal disease, and history of previous treatment. Excel and SPSS17.0 were used to analyze the data, including non parametric, descriptive, x2 test, and rank test. (P0.05 for statistical difference.)
[results in]450 cases, the ratio of men and women was 1:1.85, the age of the patients was 0.5-74 years old, the average age was (32.3 + 14.1) years old, and about 1/2 patients were first onset between 21-40 years old. The course of disease was more than 10 years in -59 years in February, accounting for 7.8%. induced or aggravating factors: no obvious inducement in 215 cases (47.8%), 114 physical factors (25.3%), 54 food factors (12%), medicine. The factors were 28 (6.2%), 22 (4.9%), 18 (4%) induced by inhalation anaphylaxis, 10 (2.2%) induced by severe exercise, 9 (2%) with gastrointestinal discomfort (2%), and 6.2% in.42.9% patients. The mental state of 10% patients was affected.
35.6% of the patients had a history of familial anaphylaxis: 87 cases of urticaria (19.3%), 54 cases of allergic rhinitis (12%), 19 cases of asthma (4.2%), 6 cases of atopic dermatitis (1.3%), 4 cases of contact dermatitis (0.9%), 19.3% cases of allergic conjunctivitis (0.2%). Chronic infectious disease was a common associated disease of CU, of which Hp infection related chronic gastritis / peptic ulceration was associated with infection. The most common cases were 121 cases (26.9%), followed by tonsillitis / pharyngitis in 77 cases (17.1%), and thyroid diseases in 34 cases (7.6%).
In clinical typing, 294 cases (65.3%) were the most common cases of chronic urticaria, followed by physical urticaria in 104 cases (23.1%), and in physical urticaria, 70 cases of skin scratches were the most common (15.6%), chronic spontaneous urticaria combined with scratches in 47 cases (10.4%). About 1/3 patients were accompanied by vascular edema and vasculality. Patients with edema are more itchy than those with non angioedema, and the severity of the wind mass in patients with angioedema also aggravates, and the duration of the wind mass is prolonged. Chronic urticaria has a certain circadian rhythm, 51.3% patients suffer from nocturnal onset or aggravation, and most chronic urticaria patients The onset of the disease is not seasonal.
Of the 411 patients with antihistamine, only a few patients were resistant to histamine resistance and still had moderate and severe itching, while more than 90% of the patients could obviously control the symptoms after taking medicine (no itching 72.3% after taking medicine 72.3%, and mild itching 21.4%). Patients about 1/5 had previously used glucocorticoid, of which 5 were alone alone. Use the drug without any H1 antihistamine drugs.
There were 169 cases of thyroid autoantibody and function test, 115 cases were normal, 57 patients had abnormal.TGAb, TMAb positive rate was 21.3%, in patients with chronic urticaria, the thyroid autoantibody, the UAS score of patients with abnormal function was higher than that of normal ones.
[conclusion]1. can cause chronic urticaria in any age group. The incidence of women is obviously more than that of men. The 21-40 year old people are the most involved. The course of chronic urticaria is different, and the duration of the disease for more than 5 years is 17.6%..
2. the most common occurrence of chronic urticaria is chronic gastritis and peptic ulcers, tonsillitis / pharyngitis. It is suggested that Hp and Streptococcus infection may be associated with the pathogenesis of chronic urticaria. Further study is needed. Some chronic urticaria is closely related to autoimmune thyroid gland disease, and thyroid autoantibodies, Patients with abnormal function have a higher UAS score.
3. chronic urticaria is the most common type of chronic urticaria in clinical typing. Physical urticaria is the most common in physical urticaria. Skin scratches can be accompanied by chronic spontaneous urticaria. About 1/3 of CU patients have both wind and vascular edema, and the extent of itching in patients with vascular edema is more than non vascular. Patients with edema were more severe, and the severity of the wind group was also aggravated in patients with vascular edema. The duration of the wind group was prolonged.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R758.24

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