本文選題：慢性蕁麻疹 + 臨床流行病學(xué)�。� 參考：《昆明醫(yī)科大學(xué)》2013年碩士論文

【摘要】：[目的]本研究通過對(duì)2010.5-2013.2來我科確診為慢性蕁麻疹的患者進(jìn)行流行病學(xué)調(diào)查,以了解慢性蕁麻疹臨床流行病學(xué)特征。 [方法]調(diào)查問卷來自中國醫(yī)師協(xié)會(huì)皮膚科醫(yī)師分會(huì)全國蕁麻疹調(diào)查CAUSE項(xiàng)目(如附件1)。選擇符合入選標(biāo)準(zhǔn)的450例慢性蕁麻疹患者,并由經(jīng)過專門培訓(xùn)的醫(yī)生詢問情況并填寫問卷調(diào)查表。內(nèi)容包括：基本情況、初發(fā)年齡、病程、誘因、臨床類型、瘙癢程度、發(fā)作時(shí)間、血管性水腫、UAS、家族過敏性疾病史、個(gè)人疾病史及既往治療史等。采用Excel及SPSS17.0對(duì)數(shù)據(jù)進(jìn)行錄入分析,包括非參數(shù)統(tǒng)計(jì)、描述性分析、x2檢驗(yàn)、秩和檢驗(yàn)等。(P0.05為存在統(tǒng)計(jì)學(xué)差異。) [結(jié)果]450例患者中,男女之比為1：1.85,患者發(fā)病年齡為0.5-74歲,平均(32.3±14.1)歲,約1/2患者在21-40歲之間初次發(fā)病。病程2月-59年,病程在10年以上,占7.8%。誘發(fā)或加重因素：無明顯誘因215例(47.8%),物理因素114例(25.3%),食物因素54例(12.0%),藥物因素28例(6.2%),精神因素22例(4.9%),吸入性過敏原誘發(fā)18例(4.0%),劇烈運(yùn)動(dòng)誘發(fā)10例(2.2%),胃腸道不適誘發(fā)9例(2.0%)。42.9%患者有不同程度睡眠障礙,10.0%患者精神狀態(tài)受到影響。 35.6%的患者有家族過敏性疾病史,分別為：蕁麻疹87例(19.3%),過敏性鼻炎54例(12.0%),哮喘19例(4.2%),特應(yīng)性皮炎6例(1.3%),接觸性皮炎4例(0.9%),過敏性結(jié)膜炎1例(0.2%)。慢性感染性疾病是CU常見的伴發(fā)病,其中以Hp感染相關(guān)的慢性胃炎/消化性潰瘍最常見為121例(26.9%),其次是扁桃腺炎/咽炎77例(17.1%),甲狀腺疾病34例(7.6%)。 臨床分型中,以慢性自發(fā)性蕁麻疹最常見294例(65.3%)；其次為物理性蕁麻疹104例(23.1%),而物理性蕁麻疹中,又以皮膚劃痕癥最常見70例(15.6%),慢性自發(fā)性蕁麻疹合并皮膚劃痕癥47例(10.4%)。約1/3的患者即有風(fēng)團(tuán)又伴有血管性水腫,有血管性水腫的患者其瘙癢程度要比無血管性水腫的患者嚴(yán)重,且有血管性水腫的患者風(fēng)團(tuán)嚴(yán)重程度亦有加重趨勢(shì),風(fēng)團(tuán)持續(xù)時(shí)間有所延長。慢性蕁麻疹發(fā)病具有一定的晝夜節(jié)律變化,51.3%患者于夜間發(fā)病或病情加重,而大多數(shù)慢性蕁麻疹患者發(fā)病無明顯季節(jié)性。 411例使用抗組胺藥物的患者中,僅少部分患者對(duì)抗組胺藥物治療抵抗,仍覺中重度瘙癢；而超過90%的患者服藥后可以明顯控制癥狀(服藥后無瘙癢占72.3%；輕度瘙癢占21.4%)。約1/5的患者既往曾系統(tǒng)使用了糖皮質(zhì)激素,其中有5例僅單獨(dú)使用該藥,不加任何H1抗組胺藥物。 有169例患者行甲狀腺自身抗體及功能檢測(cè),115例患者結(jié)果示正常,57例患者出現(xiàn)異常。TGAb、TMAb陽性率為21.3%,在慢性蕁麻疹患者中甲狀腺自身抗體、功能異常的患者UAS評(píng)分比正常者更高。 [結(jié)論]1.任何年齡人群均可發(fā)生慢性蕁麻疹,女性發(fā)病明顯多于男性,21-40歲人群受累最多。慢性蕁麻疹病程長短不一,病程長達(dá)5年以上的患者占17.6%。 2.慢性蕁麻疹患者最常見的伴發(fā)病是慢性胃炎及消化性潰瘍、扁桃腺炎／咽炎,提示我們Hp及鏈球菌感染可能與慢性蕁麻疹的發(fā)病存在一定關(guān)聯(lián),有待進(jìn)一步研究。部分慢性蕁麻疹與自身免疫性甲狀腺疾病有密切關(guān)系,甲狀腺自身抗體、功能異常的患者UAS評(píng)分更高。 3.慢性蕁麻疹的臨床分型中以慢性自發(fā)性蕁麻疹最常見,物理性蕁麻疹中又以皮膚劃痕癥最為常見,皮膚劃痕癥可并慢性自發(fā)性蕁麻疹同時(shí)存在。約1/3的CU患者既有風(fēng)團(tuán)又伴有血管性水腫,有血管性水腫的患者其瘙癢程度要比無血管性水腫的患者更為嚴(yán)重,而且有血管性水腫的患者風(fēng)團(tuán)嚴(yán)重程度亦有加重趨勢(shì),風(fēng)團(tuán)持續(xù)時(shí)間有所延長。
[Abstract]:[Objective] to investigate the clinical epidemiological characteristics of chronic urticaria by an epidemiological survey of patients with chronic urticaria confirmed by 2010.5-2013.2 in our department.
[Methods] the questionnaire came from the CAUSE project of the national urticaria Survey (Annex 1) of the Chinese Medical Doctor Association Department of dermatologists (such as Annex 1). 450 patients with chronic urticaria were selected in accordance with the criteria of admission and were asked by a trained doctor and filled out the questionnaire. The contents include the basic situation, the initial age, the course of the disease, the inducement, the clinical class. Type, itching, seizure time, vascular edema, UAS, family history of anaphylaxis, history of personal disease, and history of previous treatment. Excel and SPSS17.0 were used to analyze the data, including non parametric, descriptive, x2 test, and rank test. (P0.05 for statistical difference.)
[results in]450 cases, the ratio of men and women was 1:1.85, the age of the patients was 0.5-74 years old, the average age was (32.3 + 14.1) years old, and about 1/2 patients were first onset between 21-40 years old. The course of disease was more than 10 years in -59 years in February, accounting for 7.8%. induced or aggravating factors: no obvious inducement in 215 cases (47.8%), 114 physical factors (25.3%), 54 food factors (12%), medicine. The factors were 28 (6.2%), 22 (4.9%), 18 (4%) induced by inhalation anaphylaxis, 10 (2.2%) induced by severe exercise, 9 (2%) with gastrointestinal discomfort (2%), and 6.2% in.42.9% patients. The mental state of 10% patients was affected.
35.6% of the patients had a history of familial anaphylaxis: 87 cases of urticaria (19.3%), 54 cases of allergic rhinitis (12%), 19 cases of asthma (4.2%), 6 cases of atopic dermatitis (1.3%), 4 cases of contact dermatitis (0.9%), 19.3% cases of allergic conjunctivitis (0.2%). Chronic infectious disease was a common associated disease of CU, of which Hp infection related chronic gastritis / peptic ulceration was associated with infection. The most common cases were 121 cases (26.9%), followed by tonsillitis / pharyngitis in 77 cases (17.1%), and thyroid diseases in 34 cases (7.6%).
In clinical typing, 294 cases (65.3%) were the most common cases of chronic urticaria, followed by physical urticaria in 104 cases (23.1%), and in physical urticaria, 70 cases of skin scratches were the most common (15.6%), chronic spontaneous urticaria combined with scratches in 47 cases (10.4%). About 1/3 patients were accompanied by vascular edema and vasculality. Patients with edema are more itchy than those with non angioedema, and the severity of the wind mass in patients with angioedema also aggravates, and the duration of the wind mass is prolonged. Chronic urticaria has a certain circadian rhythm, 51.3% patients suffer from nocturnal onset or aggravation, and most chronic urticaria patients The onset of the disease is not seasonal.
Of the 411 patients with antihistamine, only a few patients were resistant to histamine resistance and still had moderate and severe itching, while more than 90% of the patients could obviously control the symptoms after taking medicine (no itching 72.3% after taking medicine 72.3%, and mild itching 21.4%). Patients about 1/5 had previously used glucocorticoid, of which 5 were alone alone. Use the drug without any H1 antihistamine drugs.
There were 169 cases of thyroid autoantibody and function test, 115 cases were normal, 57 patients had abnormal.TGAb, TMAb positive rate was 21.3%, in patients with chronic urticaria, the thyroid autoantibody, the UAS score of patients with abnormal function was higher than that of normal ones.
[conclusion]1. can cause chronic urticaria in any age group. The incidence of women is obviously more than that of men. The 21-40 year old people are the most involved. The course of chronic urticaria is different, and the duration of the disease for more than 5 years is 17.6%..
2. the most common occurrence of chronic urticaria is chronic gastritis and peptic ulcers, tonsillitis / pharyngitis. It is suggested that Hp and Streptococcus infection may be associated with the pathogenesis of chronic urticaria. Further study is needed. Some chronic urticaria is closely related to autoimmune thyroid gland disease, and thyroid autoantibodies, Patients with abnormal function have a higher UAS score.
3. chronic urticaria is the most common type of chronic urticaria in clinical typing. Physical urticaria is the most common in physical urticaria. Skin scratches can be accompanied by chronic spontaneous urticaria. About 1/3 of CU patients have both wind and vascular edema, and the extent of itching in patients with vascular edema is more than non vascular. Patients with edema were more severe, and the severity of the wind group was also aggravated in patients with vascular edema. The duration of the wind group was prolonged.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R758.24

【共引文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 陶艷霞;慢性蕁麻疹弓形蟲感染的病因?qū)W探討及患者ASST臨床隨訪[D];昆明醫(yī)科大學(xué);2013年

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本文編號(hào)：1922678