78例关节病型银屑病回顾性临床分析

发布时间：2018-06-07 01:17

本文选题：关节病型银屑病 + 临床分析　；参考：《兰州大学》2017年硕士论文

【摘要】：背景:关节病型银屑病是临床上常见的疾病,其病因及发病机理尚不明确,临床表现复杂多样,病情差异较大,严重者有致残性,且无安全有效的根治方法,部分患者因早期表现不典型而被误诊,因此对其身心健康产生严重威胁。目的:了解关节病型银屑病的临床特征,提高对本病的认识。方法:收集2012年3月至2016年9月于兰州大学第二医院皮肤科和风湿免疫科住院的78例关节病型银屑病患者的临床资料,包括一般信息、首发症状及时间、临床特征、合并疾病、实验室检查、影像学检查及治疗等,选择诊断标准,并采用社会科学统计软件包21.0进行分析。结果:78例患者中男性47例(60.25%),女性31例(39.74%),男女之比1.5:1,患者年龄为8岁-73岁,皮损平均发病年龄:27.85±10.95岁,关节炎平均发病年龄37.72±13.12岁。从发生银屑病皮损至出现关节受累的平均时间间隔11年。皮损症状首发65例(83.33%),关节症状首发6例(7.69%),同时出现症状7例(8.97%)。皮损表现类型中,寻常型银屑病皮损71例(91.02%),脓疱型银屑病皮损6例(7.69%),红皮病型银屑病皮损1例(1.28%)。临床分类中脊柱关节病型较多见30.77%(24例),其次为远端指(趾)关节炎型,占26.92%(21例),非对称少数关节炎型,占20.51%(16例),对称性多关节炎型,占11.54%(9例)及残毁性关节炎型,占10.26%(8例)。男性较女性易发生指(趾)甲损害(P0.05)。HLA-B27阳性患者30例(占检测者71.43%),HLA-B27在中轴关节的出现频率高于外周关节(P0.05)。RF阳性患者仍可被诊断为关节病型银屑病。X线、CT检查常见的改变有关节间隙变窄,骨质密度减低,关节面毛糙、模糊;亦可见一些不常见的影像学改变,如骨刺形成,关节骨性融合或半脱位,骨质侵蚀和关节残毁性损害等。超声多表现为滑膜增生、增厚,关节腔积液,骨侵蚀,附着点炎,腱鞘炎,滑囊炎。结论:本研究中关节病型银屑病患者男性略多于女性;银屑病皮损的发生多早于关节炎;PsA的皮损多表现为寻常型银屑病皮损;关节病型银屑病几乎可累及全身各个大小关节,受累最频繁的为中轴关节;PsA患者中HLA-B27的阳性率在中轴关节显著高于外周关节;与女性关节病型银屑病患者相比,男性患者更易出现指(趾)甲损害;RF阳性并不能完全排除关节病型银屑病的诊断,临床分型随病程或时间变化而变化,现有的诊断分类标准有待完善。
[Abstract]:Background: psoriasis is a common clinical disease, its etiology and pathogenesis are not clear, its clinical manifestations are complicated and varied, the disease varies greatly, the severe patients have disability, and there is no safe and effective radical cure. Some of the patients were misdiagnosed because their early manifestations were atypical, so it posed a serious threat to their physical and mental health. Objective: to understand the clinical features of psoriasis of arthropathy and to improve the understanding of this disease. Methods: from March 2012 to September 2016, 78 patients with psoriasis of arthropathy were collected from Department of Dermatology and Rheumatological Immunology, second Hospital of Lanzhou University, including general information, initial symptoms and time, clinical features, and complicated diseases. Laboratory examination, imaging examination and treatment, diagnostic criteria were selected and analyzed by social science statistical software package 21.0. Results among the 78 patients, 47 were male (60.25) and 31 were female (39.74). The ratio of male to female was 1.5: 1. The age of the patients was 8 to 73 years old, the average age of skin lesions was 27.85 卤10.95 years old, and the average age of arthritis was 37.72 卤13.12 years old. The average interval from psoriatic lesions to joint involvement was 11 years. The symptoms of skin lesions were first found in 65 cases (83.33), joint symptoms in 6 cases (7.69%) and symptoms in 7 cases (8.97%) at the same time. There were 71 cases of psoriasis vulgaris, 6 cases of pustular psoriasis, 1 case of erythroderma psoriasis and 1 case of erythroderma psoriasis, among which there were 71 cases of psoriasis vulgaris, 6 cases of pustular psoriasis and 1 case of erythroderma psoriasis. In the clinical classification, there were 30.77 cases of spondyloarthropathy, followed by distal finger (toe) arthritis (26.92 cases), asymmetric arthritic type (20.51 cases), symmetrical polyarthritis type (11.54%) and residual destructive arthritis type (10.2626 8 cases). Thirty male (71.43) male patients with P0.05 or HLA-B27 positive for nail lesion of finger (toe) were more likely to present HLA-B27 in the central axial joint than in the peripheral joint (P0.05). RF positive patients could still be diagnosed as psoriasis. X ray CT scan was common in the diagnosis of psoriasis arthropathy in 30 male patients (71.43%), and the incidence rate of HLA-B27 was higher than that of peripheral joint (P0.05). RF positive patients could still be diagnosed as psoriasis of arthropathy. The change has a narrowing of the joint space, Some unusual imaging changes such as bone spines bone fusion or subluxation bone erosion and residual joint damage can also be seen. Ultrasound showed synovial hyperplasia, thickening, joint cavity effusion, bone erosion, attachment point inflammation, tenosynovitis, bursitis. Conclusion: in this study, the number of patients with psoriasis of arthropathy is slightly more than that of female, the lesion of psoriasis is earlier than that of PsA of arthritis, the lesion of psoriasis vulgaris is more than that of psoriasis vulgaris, the psoriasis of arthropathy can involve almost every joint of the whole body. The positive rate of HLA-B27 was significantly higher in the central axis joint than that in the peripheral joint in the PsA patients with the most frequent involvement, and was significantly higher than that in the female patients with psoriasis arthropathy. The diagnosis of psoriasis of arthropathy can not be completely excluded by RF positive of nail lesion in male patients. The clinical classification changes with the course of disease or time, and the existing diagnostic classification criteria need to be improved.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R758.63

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