53例泛发性脓疱型银屑病病例分析

发布时间：2018-10-10 14:30

【摘要】：目的：探讨泛发型脓疱型银屑病的病因、诱发和加重因素、临床表现、相关实验室检查及治疗方案,为临床诊断及治疗提供参考。方法：收集整理山东大学齐鲁医院皮肤科2005年～2012年住院治疗的53例GPP患者的病历资料,对其此次发病因素、临床表现、实验室相关检查、治疗方法等进行回顾性分析,借助计算机SPSS17.0次件,应用t检验、方差分析等对临床资料进行统计学分析。结果：(1)53例病例中.实际患者为42人,有11人因疾病反复发作而数次入院(2～4次)。男22人,女20人,男：女=1.1：1,平均年龄27.98±17.6岁(2～65岁)；PSO-患者初次发生脓疱型银屑病的年龄24.7±14.87岁,PSO~+患者初次发生脓疱型银屑病的年龄为35.75±15.65岁,两者比较差异有统计意义(p0.01)；(2)有明确发病诱因者37例(69.8%),有上呼吸道感染史14例(26.5%),用药不当9例(17.0%)；生活事件5例(9.4%)；外伤5例(9.4%),内分泌因素4例(7.5%)；无明显诱因者16例(30.2%)。合并感染的14例GPP患者与无明显诱因者的16例GPP患者入院体温、WBC计数及脓疱消退时间比较差异有统计学意义；37例(69.8%)发病于春冬季节,余16例(30.2%)发病于夏秋季节；(3)全身骤起脓疱14例,皮疹初发于头面部6例,四肢11例,躯干17例,褶皱部位4例,有1例起于一指(趾)；皮疹多全身泛发,多为针尖大小的脓疱,部分(41.5%)融合成“脓湖”。19例(35.8%)患者入院时有皮肤触痛；6例(11.3%)患者出现关节酸胀、疼痛症状；沟纹舌8例(15.1%)；(4)实验室检查脓疱型银屑病患者WBC、N%及血清钙、血清白蛋白、总蛋白治疗前后比较差异有统计学意义；(5)不同组合的药物治疗脓疱消退时间不同。结论：(1)泛发型脓疱型银屑病可发生于任何年龄,男女均罹患,且pso-的GPP发病年龄较pso+的GPP早；(2)脓疱型银屑病好发于春冬季节；有多种诱发因素,尤以感染因素常见,且能加重病情,给予抗生素治疗有利于病情恢复；(3)WBC计数、血清钙及白蛋白可作为评估病情及转归的重要参考指标；(4)目前阿维A和MTX仍为GPP一线用药,首选阿维A,病情严重者可酌情联合应用糖皮质激素、类激素药物等。
[Abstract]:Objective: to investigate the etiology, inducing and exacerbation factors, clinical manifestations, laboratory examination and treatment of generalized pustular psoriasis, in order to provide reference for clinical diagnosis and treatment. Methods: the medical records of 53 GPP patients hospitalized in the Department of Dermatology, Qilu Hospital, Shandong University from 2005 to 2012 were collected and analyzed retrospectively. With the help of computer SPSS17.0, t-test and ANOVA were used to analyze the clinical data. Results: (1) 53 cases. The actual number of patients was 42, 11 patients were admitted several times due to recurrent attacks (24 times). 22 males and 20 females, male: female = 1.1: 1, mean age 27.98 卤17.6 years (2.65 years), the age of first onset of pustular psoriasis in PSO- patients was 24.7 卤14.87 years old, the age of PSO~ patients with pustular psoriasis was 35.75 卤15.65 years old, the difference was statistically significant (p0.01). (2) there were 37 cases (69.8%) with definite inducement, 14 cases (26.5%) with history of upper respiratory tract infection, 9 cases (17.0%) with improper medication, 5 cases (9.4%) with life events, 5 cases (9.4%) with trauma, 4 cases (7.5%) with endocrine factors, and 16 cases (30.2%) with no obvious inducement. There were significant differences in body temperature, WBC count and pustular extinction time between 14 GPP patients with infection and 16 GPP patients without obvious inducement, 37 cases (69.8%) were in spring and winter season, the remaining 16 cases (30.2%) occurred in summer and autumn seasons. (3) there were 14 cases of systemic pustules, 6 cases of skin rash, 11 cases of extremities, 17 cases of trunk, 4 cases of fold, and 1 case originated from one finger (toe). 19 patients (35.8%) had skin tenderness on admission, 6 patients (11.3%) had joint acidosis and pain symptoms, 8 patients (15.1%); (4) with sulcus tongue had WBC,N% and serum calcium and serum albumin in the laboratory examination of pustule psoriasis. Total protein before and after treatment has statistical significance; (5) different combinations of drug treatment pustular extinction time is different. Conclusion: (1) Psoriasis may occur at any age, both male and female, and the onset of GPP in pso- is earlier than that of GPP in pso, (2) Psoriasis is prone to occur in spring and winter, and there are a variety of predisposing factors, especially infection factors. (3) WBC count, serum calcium and albumin can be used as an important reference index to evaluate the state of illness and prognosis. (4) Avera and MTX are still first-line drugs for GPP. Avera is the first choice, serious patients can use glucocorticoid, hormone-like drugs and so on.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R758.63

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