本文選題：重型痤瘡　切入點(diǎn)：青春期　出處：《中國全科醫(yī)學(xué)》2014年23期 　論文類型：期刊論文

【摘要】：目的分析不同性別、年齡重型痤瘡患者的臨床特征,為重型痤瘡尋找更有針對(duì)性的治療方法提供依據(jù)。方法 2009—2011年采用抽樣調(diào)查法,從我國24個(gè)城市的35家三級(jí)甲等醫(yī)院皮膚科門診選取1 944例重型痤瘡患者。采用《尋常痤瘡遺傳流行病學(xué)調(diào)查問卷》由2位經(jīng)驗(yàn)豐富的皮膚科臨床醫(yī)師評(píng)估患者皮損類型、數(shù)量及分布部位并指導(dǎo)填寫調(diào)查問卷。結(jié)果 1 944例重型痤瘡患者中,男1 000例,女944例;青春期痤瘡1 433例,其中男842例(58.8%)、女591例(41.2%);成人痤瘡511例,其中男158例(30.9%)、女353例(69.1%)。不同類型痤瘡在男、女性患者中的分布情況比較,差異有統(tǒng)計(jì)學(xué)意義(χ2=116.60,P0.001)。成人痤瘡包括青春期發(fā)病持續(xù)到25歲以后的持續(xù)性痤瘡377例(73.5%),25歲以后發(fā)病的遲發(fā)型痤瘡134例(26.5%)。353例女性成人痤瘡患者中,238例(67.4%)為持續(xù)性痤瘡,115例(32.6%)為遲發(fā)型痤瘡;158例男性成人痤瘡中,139例(88.0%)為持續(xù)性痤瘡,19例(12.0%)為遲發(fā)型痤瘡。男、女性成人痤瘡均以持續(xù)性痤瘡為主,但女性遲發(fā)型痤瘡發(fā)生率高于男性,差異有統(tǒng)計(jì)學(xué)意義〔χ2=23.36,OR=2.71,95%CI(1.73,4.23),P0.001〕。716例(36.8%)患者有痤瘡家族史,其中男349例,女367例;青春期痤瘡569例(79.5%),持續(xù)性痤瘡130例(18.1%),遲發(fā)型痤瘡17例(2.4%)。有痤瘡家族史的男、女性患者中,男性青春期痤瘡發(fā)生率高于女性,而女性持續(xù)性痤瘡、遲發(fā)型痤瘡發(fā)生率高于男性(P0.05)。女性重型痤瘡患者中,從皮損數(shù)量來看:青春期痤瘡丘疹/膿皰的數(shù)量較持續(xù)性痤瘡(Z=2.39,P=0.017)多,與遲發(fā)型痤瘡(Z=1.25,P=0.210)接近;青春期痤瘡(Z=-3.87,P0.001)及持續(xù)性痤瘡(Z=-3.68,P0.001)萎縮性瘢痕的數(shù)量較遲發(fā)型痤瘡多;粉刺(χ2=2.48,P=0.290)、結(jié)節(jié)/囊腫(χ2=1.94,P=0.379)及增生性瘢痕(χ2=4.40,P=0.106)的數(shù)量在不同類型痤瘡間差異無統(tǒng)計(jì)學(xué)意義。從皮損分布部位來看:與青春期痤瘡相比,持續(xù)性痤瘡額頭、面頰出現(xiàn)丘疹/膿皰的發(fā)生率較低,背部出現(xiàn)結(jié)節(jié)/囊腫,下頜出現(xiàn)萎縮性瘢痕的發(fā)生率較高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);遲發(fā)型痤瘡鼻部出現(xiàn)萎縮性瘢痕的發(fā)生率較青春期痤瘡高(P0.05)。男性重型痤瘡患者中,從皮損數(shù)量來看:粉刺(χ2=0.07,P=0.966)、丘疹/膿皰(χ2=1.02,P=0.600)、結(jié)節(jié)/囊腫(χ2=0.31,P=0.857)、增生性瘢痕(χ2=3.37,P=0.186)及萎縮性瘢痕(χ2=5.03,P=0.081)的數(shù)量在不同類型痤瘡間差異均無統(tǒng)計(jì)學(xué)意義。從皮損分布部位來看:青春期痤瘡面頰遺留萎縮性瘢痕的發(fā)生率為48.0%(404/842),高于遲發(fā)型痤瘡的36.8%(7/19),差異有統(tǒng)計(jì)學(xué)意義〔χ2=5.00,OR=1.60,95%CI(1.06,2.41),P=0.025〕。結(jié)論重型痤瘡中青春期痤瘡發(fā)生率最高,成人痤瘡以青春期后的持續(xù)性痤瘡為主,女性出現(xiàn)成人痤瘡,特別是遲發(fā)型痤瘡的風(fēng)險(xiǎn)較男性高。痤瘡家族史對(duì)青春期痤瘡及女性成人痤瘡的影響較大。
[Abstract]:Objective to analyze the clinical features of different gender, age of severe acne patients, provide the basis for targeted therapies for severe acne. Looking for a better method from 2009 to 2011 by sampling survey method, from the 24 city in China 35 three level of first-class hospital outpatient department of Dermatology from 1944 patients with heavy acne acne vulgaris. The "genetic epidemiology the questionnaire > type lesions of patients with by 2 experienced clinicians to assess the quantity and distribution of the Department of Dermatology, and to guide the site to fill in the questionnaire. The results of 1944 cases of severe acne patients, male 1000 cases, female 944 cases; adolescent acne 1433 cases, 842 cases were male (58.8%), 591 cases of female adults (41.2%); 511 cases of acne, 158 cases were male (30.9%), 353 cases were female (69.1%). Different types of acne in male, compared the distribution of female patients, the difference was statistically significant (2=116.60, P0.001) including adolescent adult acne. The incidence of persistent acne until 25 years later in 377 cases (73.5%), after 25 years the incidence of late-onset acne in 134 cases (26.5%).353 cases of female adult acne patients, 238 cases (67.4%) for persistent acne, 115 cases (32.6%) were late onset acne; 158 cases of male adult acne. 139 cases (88%) for persistent acne, 19 cases (12%) were late onset acne. Male and female adult acne were dominated by persistent acne, but female delayed acne was higher than that in males, the difference was statistically significant, X 2=23.36, OR=2.71,95%CI (1.73,4.23), P0.001.716 (36.8%) cases of patients a family history of acne, male 349 cases, female 367 cases; 569 cases of acne vulgaris (79.5%), persistent acne (18.1%), 130 cases of late-onset acne in 17 cases (2.4%). There is a family history of acne of male and female patients, male adolescent acne incidence was higher than female, while female persistent acne the high incidence of late-onset acne. In the male (P0.05). Female severe acne lesions, from the number of adolescent acne pimples / pustules over the number of persistent acne (Z=2.39, P=0.017), and late onset acne (Z=1.25, P=0.210) approach; adolescent acne (Z=-3.87, P0.001) and persistent acne (Z=-3.68, P0.001) the number of atrophy scar than late-onset acne acne; (x 2=2.48, P=0.290), nodule or cyst (x 2=1.94, P=0.379) and hypertrophic scar (2=4.40, P=0.106) the number of differences in different types of acne have no statistical significance. From the skin loss distribution location: compared with adolescent acne, persistent acne forehead the cheek, papules pustules / lower incidence of back nodule or cyst, mandibular appeared atrophic scar occurred at a higher rate, the difference was statistically significant (P0.05); late onset acne nose appeared atrophic scar is high incidence of adolescent acne (P0.05) Male. Severe acne, acne lesions from number: (x 2=0.07, P=0.966), papules and pustules (2=1.02, P=0.600), nodule or cyst (x 2=0.31, P=0.857), hypertrophic scar (2=3.37, P=0.186) and atrophic scar (x 2=5.03, P=0.081) the difference in the number of different types of acne had no statistical significance. From the distribution of lesions location: left cheek adolescent acne atrophic scar occurred in 48% (404/842), higher than late onset acne (36.8% 7/19), the difference was statistically significant, X 2=5.00, OR=1.60,95% CI (1.06,2.41), P=0.025. The highest rate of adolescent acne conclusion severe acne, adult acne with persistent acne after puberty, female adult acne, especially the risk of late-onset acne is higher than male. Influence of family history on adolescent acne acne and acne in female adults.

【作者單位】： 昆明醫(yī)科大學(xué)第一附屬醫(yī)院皮膚性病科/醫(yī)療美容科 云南省皮膚病研究所;昆明醫(yī)科大學(xué)基礎(chǔ)醫(yī)學(xué)院生理學(xué)教研室;昆明醫(yī)科大學(xué)科技處;
【基金】：國家自然科學(xué)基金資助項(xiàng)目(81060123,81360234) 云南省應(yīng)用基礎(chǔ)研究計(jì)劃項(xiàng)目(2011FA028,2012FB004)
【分類號(hào)】：R758.733

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