本文選題：漢族　切入點：尋常型銀屑病　出處：《大連醫(yī)科大學》2013年碩士論文　論文類型：學位論文

【摘要】：目的：銀屑病是一種反復(fù)發(fā)作性慢性炎癥性皮膚病，迄今為止被認為是一種單一的疾病。但是，最近的研究顯示早發(fā)型銀屑病與晚發(fā)型銀屑病在病理生理上和治療愈后上存在差異，也就提示了銀屑病間存在不同亞型�；谶@種假設(shè)，幾年前法國的皮膚科醫(yī)師通過問卷調(diào)查的方式收集了大量的銀屑病患者的資料，這些資料包括銀屑病的主要臨床特征的綜合信息。再通過因素分析法、群集分析法和判別函數(shù)等統(tǒng)計學方法進行分類，最終成功的將1484名銀屑病患者分成了6個臨床亞型。這項研究為重點研究同質(zhì)組患者的遺傳學、遺傳藥理學、病理生理學和治療學方面開辟了新的道路。關(guān)于本次研究的目的是驗證此種方法是否同樣適用于中國漢族人群中的尋常型銀屑病患者。 方法：本次研究采用了前瞻性流行病學研究方法，我們根據(jù)研究目的設(shè)計了特定的問卷以收集患者資料，本次研究共收集了中國東北地區(qū)的455例尋常型銀屑病患者的臨床特征資料。然后采用逐步聚類分析方法對患者進行分析。 結(jié)果：最終將這455例患者分成了5個亞型組： 第一型：共40人，占總樣本量的8.8%，本組患者以男性為主；發(fā)病較晚，多在30至50歲之間發(fā)�。皇状伟l(fā)病皮損多為點滴型；病程進展多為間斷性；大多數(shù)患者無銀屑病家族史；同形反應(yīng)明顯；病情嚴重程度受季節(jié)變化影響較大；病情最嚴重時皮膚受累面積較大。相對于其它部位軀干受累更明顯。第二型：共72人，占總樣本量的15.8%，患者間無明顯性別差別；發(fā)病較早，多30歲以前發(fā)��；首次發(fā)病以點滴型皮損或錢幣狀皮損為主，且兩者之間無明顯差別。第三型：共70人，占總樣本量的15.4%，患者間無明顯性別差別；發(fā)病較晚，，多在30至50歲之間發(fā)�。皇状伟l(fā)病可為點滴型皮疹或錢幣狀皮疹，以點滴型為主；多有銀屑病家族史；病情最嚴重時皮膚受累面積較小。第四型：共29人，占總樣本量的6.4%，患者間無明顯性別差別；任何年齡都可發(fā)病但以多在30至50歲之間發(fā)病為主；首次發(fā)病時皮疹為大斑塊樣或錢幣狀；無銀屑病家族史；同形反應(yīng)不明顯；病情變化受季節(jié)影響不明顯。第五型：共244人，為樣本量最大的一組，占總樣本量的53.6%，本型患者無明顯性別差異；發(fā)病年齡較早，多在30歲之前發(fā)�。皇状伟l(fā)病可為點滴型皮疹或錢幣狀皮疹，以點滴型為主；有銀屑病家族史；病情嚴重程度受季節(jié)變化影響較大；病情最嚴重時皮膚受累面積較小。 結(jié)論：本研究提示依據(jù)尋常型銀屑病的臨床特征通過逐步聚類分析法對其分型同樣適用于中國漢族局部區(qū)域的人群，通過此類方法所分得亞型之間可能存在遺傳學和病理生理學的差異，同時在臨床治療方面起到一定的提示作用。
[Abstract]:Objective: psoriasis is a recurrent chronic inflammatory dermatosis that has been considered to be a single disease. Recent studies have shown differences in pathophysiological and therapeutic outcomes between early and late psoriasis, suggesting different subtypes of psoriasis. A few years ago, French dermatologists collected a large number of data on psoriasis patients through questionnaires, including comprehensive information on the main clinical characteristics of psoriasis. Statistical methods such as cluster analysis and discriminant function were used to classify 1484 psoriasis patients into 6 clinical subtypes. Pathophysiology and therapeutics have opened up a new path. The aim of this study is to verify whether the same method is applicable to psoriasis vulgaris in Chinese Han population. Methods: a prospective epidemiological study was used in this study. We designed a specific questionnaire to collect patient data according to the objective of the study. The clinical data of 455 patients with psoriasis vulgaris in Northeast China were collected in this study. Results: the 455 patients were divided into 5 subgroups:. Type I: 40 patients, who accounted for 8.8% of the total sample size. The patients were mainly male; the patients were late onset, most of them were between 30 and 50 years old; the first onset of skin lesions were mostly drip type; the course of disease was mostly intermittent; most of the patients had no family history of psoriasis, the majority of the patients had no family history of psoriasis, and most of the patients had no family history of psoriasis. The isomorphic reaction was obvious; the severity of the disease was affected by seasonal changes; the skin involvement area was larger when the disease was most serious, and the involvement was more obvious than that in other parts of the trunk. Type 2: 72 people, There was no significant gender difference among the patients; the onset was earlier, more than 30 years old; the first onset was mainly of drip-down or coin-like lesions, and there was no significant difference between the two. Type III: a total of 70 people, 15.4% of the total samples, there was no significant gender difference among the patients; the onset of the disease was late, mostly between 30 and 50 years old; the first onset could be a drip rash or a coin-like rash, mainly a drip type; most of them had a family history of psoriasis. The area of skin involvement was small when the disease was most serious. Type 4th: 29 people were involved, which accounted for 6.4% of the total sample size, and there was no significant gender difference between the patients, but most of them were from 30 to 50 years old. At the first onset, the rash was large plaques or coins; there was no family history of psoriasis; homotypic reactions were not obvious; changes in the disease were not significantly affected by seasons. Type 5th: a total of 244 people, the largest sample group, There was no significant gender difference in the patients with this type, the onset was earlier than the age before 30 years of age, the first onset could be a drip-type rash or a coin-like rash, mainly a drip type, with a family history of psoriasis. The severity of the disease was affected by seasonal changes, and the area of skin involvement was small when the disease was most serious. Conclusion: according to the clinical characteristics of psoriasis vulgaris, the classification of psoriasis vulgaris by stepwise cluster analysis is also applicable to the local population of Han nationality in China. There may be genetic and pathophysiological differences among the subtypes obtained by this method, and they may also play a role in clinical therapy.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R758.63

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