青斑血管病患者临床特点、生活质量及血浆脂蛋白a水平的分析

发布时间：2018-07-29 19:35

【摘要】：青斑血管病(Livedoid vasculopathy,LV)是由于局部皮肤血管血栓形成引起的疾病。主要表现为好发于小腿、踝部的红色、紫癜样斑疹、丘疹,形成疼痛的溃疡,最终遗留瓷白色萎缩瘢痕,周围有毛细血管扩张和周围色素沉着。该病发病机制不清,现多认为该病与局部血栓形成及其他自身免疫病相关。本研究主要分析青斑血管病患者的临床表现、实验室检查、生活质量及血浆脂蛋白a水平。第1部分青斑样血管病患者临床分析目的分析青斑样血管病患者的临床特点,总结疾病的发病规律及特点,进一步探究病因,指导临床决策。方法选取2016年就诊我院的32例青斑血管病患者,回顾性分析其临床表现,实验室检查结果。结果男性患者18例,女性14例,二者比例为1.3:1,患者平均年龄(25.19±13.54)岁,平均发病年龄(19.97±11.93)岁。7例患者皮损累及双足,25例患者小腿有不同程度受累,其中1例患者毛细血管扩张累及大腿。所有患者有白色萎缩及不同程度的色素沉着,3例患者无溃疡的发生,其余29例患者均有不同程度的溃疡。32例患者中,11例患者合并毛细血管扩张,14例患者出现紫癜。26例患者有不同程度的疼痛,其中2例患者同时自觉瘙痒。30例患者表现为夏重冬轻,2例患者发病无明显季节性;4例患者表示站立或运动后病情加重。本组患者中出现5例抗β2GP-1升高,1例ACA升高,另外有3例ANA升高,1例抗O升高,1例患者出现C3降低,1例患者RO/ssA52阳性。结论本组患者出现不同自身抗体升高,提示自身免疫机制在发病中起作用。本组患者发病年龄更轻,无下肢静脉曲张等血管疾患及自身免疫性疾病的证据,应归类于特发性青斑血管病。此类患者可能存在凝血、纤溶相关基因的异常,造成局部血栓形成,为我们未来的研究提供了良好的思路和方向。第2部分青斑样血管病患者生活质量评估目的探讨青斑血管病对患者生活质量的影响,评估患者病情,指导临床治疗。方法用DLQI量表测量LV患者的生活质量,用信度、效度分析评估DLQI的信度与效度。结果共22名患者参加问卷,男性13名,女性9名,平均年龄为(33.00±3.07)岁,平均病程为(5.93±1.05)年。DLQI评分1～16分,平均(6.64±0.86)分。患者在休闲娱乐方面影响最大,其次为治疗、症状与感受。人际关系基本不受疾病影响。在总分、症状与感受、日常生活方面女性的得分高于男性。年龄和症状与感受呈负相关。信度分析显示F= 52.66(P0.05),Hotelling 的 T 平方值为348.779,F=29.06(P0.05),Cronbach's Alpha值为0.759,无剔除项目。各维度相关系数都在0.202-0.721之间,说明该量表具有良好的内部效度与信度。结论LV患者生活受中等程度影响。女性影响高于男性;年龄越小,在症状与感受方面受影响越大。DLQI量表有较好的信度和效度可以评估患者生活质量,在一定程度上反映病情并指导治疗。第3部分脂蛋白a水平与青斑血管病相关性研究目的测定青斑样血管病患者与健康人血清脂蛋白a水平,探究其是否与青斑血管病有相关性。方法运用免疫比浊法对2013年——2016年44例患者及44例健康人对照进行血清脂蛋白a测定,分析两组测量值及异常值是否有差异。结果实验组、对照组分别测定44例病例,二组在年龄、性别均无统计学差异。对照组均值为(12.97±16.20)mg/dl,实验组为(18.18±20.50)mg/dl,t=0.189(P0.05),两组结果无统计学差异。对照组、实验组分别有6例(13.64%)、12例(27.27%)患者大于30mg/dl。皮尔逊卡方检验值为2.514(P0.05),两组无显著性差异。结论患者与对照组血清中脂蛋白a水平并无差异,脂蛋白a升高并不能作为诊断疾病的特异性指标,但其存在仍有可能参与LV的发生与发展,其作用机制还需要进一步探索。
[Abstract]:Livedoid vasculopathy (LV) is a disease caused by local vascular thrombosis. It is mainly manifested in the red, purpura skin rash, papules, and painful ulcers in the calves, purpura like rash, papules, and the final white atrophy of porcelain, with capillary dilatation and peripheral pigmentation around it. The pathogenesis is unclear, now the pathogenesis is unclear. Most of the disease was associated with local thrombosis and other autoimmune diseases. This study mainly analyzed the clinical manifestations, laboratory examination, quality of life and plasma lipoprotein a levels of the patients with green macular disease. The clinical analysis of first parts of the patients with green spot like vascular disease was analyzed and the clinical characteristics of the patients with CVD were analyzed and the disease was summarized. Rules and characteristics, further explore the etiology, guide clinical decision-making. Methods selected 32 cases of green spot angiopathy in our hospital in 2016, retrospective analysis of the clinical manifestations, laboratory results. Results of male patients 18 cases, 14 cases of women, two of the proportion of 1.3:1, the average age (25.19 + 13.54) years, the average age of onset (19.97 + 11.93) years of age. In.7 patients, the skin lesions involved BIPS. 25 patients had different degrees of involvement in the calf, of which 1 patients had telangiectasia involved in the thigh. All patients had white atrophy and varying degrees of pigmentation, 3 cases had no ulcers, the other 29 patients had different degrees of ulceration in.32 patients, and 11 cases with telangiectasia. 14 cases of patients with purpura.26 had different degrees of pain, of which 2 patients with conscious itching were mild in summer and mild in summer, 2 patients had no seasonal seasonal onset; 4 patients indicated that there were 5 cases of anti beta 2GP-1 elevation, 1 ACA elevated, 3 increased ANA and 1 anti O in this group. C3 decreased in 1 patients and 1 patients were positive for RO/ssA52. Conclusion the patients in this group have different autoantibodies, suggesting that the autoimmune mechanism may play a role in the onset of the disease. This group of patients have less age, no varicose veins of lower extremity and the evidence of autoimmune diseases, and should be classified as idiopathic green plaque disease. There may be abnormal blood clotting and fibrinolysis related genes, causing local thrombosis and providing a good way of thinking and direction for our future research. Second part of the quality of life assessment of the patients with green spot like angiopathy is to discuss the effect of green spot vascular disease on the quality of life of the patients, evaluate the patient's condition, guide the clinical treatment. Methods use the DLQI quantity. The reliability and validity of DLQI were assessed by reliability and validity analysis. Results 22 patients participated in the questionnaire, 13 men and 9 women, the average age was (33 + 3.07) years, the average course of disease was (5.93 + 1.05) years.DLQI score 1~16, and the average (6.64 + 0.86) score. The patients had the greatest impact on leisure and entertainment, followed by treatment. F= 52.66 (P0.05), T square value of Hotelling was 348.779, F=29.06 (P0.05), Cronbach's Alpha value 0.759, and no elimination item. The dimension correlation coefficient is between 0.202-0.721, which shows that the scale has good internal validity and reliability. Conclusion the life of LV patients is influenced by moderate degree. The influence of women is higher than that of men; the smaller the age, the greater the influence of the symptoms and feelings, the better reliability and efficiency of the.DLQI scale can evaluate the quality of life of the patient, to a certain extent. To reflect the condition and guide the treatment. Third correlation between the level of lipoprotein A and green spot angiopathy. Objective to determine the level of serum lipoprotein a in the patients with green spot like vascular disease and healthy people, to explore whether it is related to the green spot vascular disease. Methods the immunoturbidimetry was used in 44 patients and 44 healthy people in 2013, in 2016. Serum lipoprotein a determination, analysis of two groups of measured values and abnormal values are different. Results in the experimental group, 44 cases in the control group, two groups in age, no statistical difference. The mean value of the control group is (12.97 + 16.20) mg/dl, the experimental group is (18.18 + 20.50) mg/dl, t=0.189 (P0.05), two group results have no statistical difference. The control group, the experiment There were 6 cases (13.64%), 12 (27.27%) patients greater than 30mg/dl. Pearson chi square test value of 2.514 (P0.05), no significant difference between the two groups. Conclusion the patients and the control group serum lipoprotein a level is not different, lipoprotein a is not a specific indicator of the diagnosis of disease, but the existence of the presence of LV is still possible to participate in the development and development of LV. The mechanism of its action needs to be further explored.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R758.6

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