本文選題：關(guān)節(jié)病型銀屑病 + 臨床分析��； 參考：《蘭州大學》2017年碩士論文

【摘要】：背景:關(guān)節(jié)病型銀屑病是臨床上常見的疾病,其病因及發(fā)病機理尚不明確,臨床表現(xiàn)復雜多樣,病情差異較大,嚴重者有致殘性,且無安全有效的根治方法,部分患者因早期表現(xiàn)不典型而被誤診,因此對其身心健康產(chǎn)生嚴重威脅。目的:了解關(guān)節(jié)病型銀屑病的臨床特征,提高對本病的認識。方法:收集2012年3月至2016年9月于蘭州大學第二醫(yī)院皮膚科和風濕免疫科住院的78例關(guān)節(jié)病型銀屑病患者的臨床資料,包括一般信息、首發(fā)癥狀及時間、臨床特征、合并疾病、實驗室檢查、影像學檢查及治療等,選擇診斷標準,并采用社會科學統(tǒng)計軟件包21.0進行分析。結(jié)果:78例患者中男性47例(60.25%),女性31例(39.74%),男女之比1.5:1,患者年齡為8歲-73歲,皮損平均發(fā)病年齡:27.85±10.95歲,關(guān)節(jié)炎平均發(fā)病年齡37.72±13.12歲。從發(fā)生銀屑病皮損至出現(xiàn)關(guān)節(jié)受累的平均時間間隔11年。皮損癥狀首發(fā)65例(83.33%),關(guān)節(jié)癥狀首發(fā)6例(7.69%),同時出現(xiàn)癥狀7例(8.97%)。皮損表現(xiàn)類型中,尋常型銀屑病皮損71例(91.02%),膿皰型銀屑病皮損6例(7.69%),紅皮病型銀屑病皮損1例(1.28%)。臨床分類中脊柱關(guān)節(jié)病型較多見30.77%(24例),其次為遠端指(趾)關(guān)節(jié)炎型,占26.92%(21例),非對稱少數(shù)關(guān)節(jié)炎型,占20.51%(16例),對稱性多關(guān)節(jié)炎型,占11.54%(9例)及殘毀性關(guān)節(jié)炎型,占10.26%(8例)。男性較女性易發(fā)生指(趾)甲損害(P0.05)。HLA-B27陽性患者30例(占檢測者71.43%),HLA-B27在中軸關(guān)節(jié)的出現(xiàn)頻率高于外周關(guān)節(jié)(P0.05)。RF陽性患者仍可被診斷為關(guān)節(jié)病型銀屑病。X線、CT檢查常見的改變有關(guān)節(jié)間隙變窄,骨質(zhì)密度減低,關(guān)節(jié)面毛糙、模糊;亦可見一些不常見的影像學改變,如骨刺形成,關(guān)節(jié)骨性融合或半脫位,骨質(zhì)侵蝕和關(guān)節(jié)殘毀性損害等。超聲多表現(xiàn)為滑膜增生、增厚,關(guān)節(jié)腔積液,骨侵蝕,附著點炎,腱鞘炎,滑囊炎。結(jié)論:本研究中關(guān)節(jié)病型銀屑病患者男性略多于女性;銀屑病皮損的發(fā)生多早于關(guān)節(jié)炎;PsA的皮損多表現(xiàn)為尋常型銀屑病皮損;關(guān)節(jié)病型銀屑病幾乎可累及全身各個大小關(guān)節(jié),受累最頻繁的為中軸關(guān)節(jié);PsA患者中HLA-B27的陽性率在中軸關(guān)節(jié)顯著高于外周關(guān)節(jié);與女性關(guān)節(jié)病型銀屑病患者相比,男性患者更易出現(xiàn)指(趾)甲損害;RF陽性并不能完全排除關(guān)節(jié)病型銀屑病的診斷,臨床分型隨病程或時間變化而變化,現(xiàn)有的診斷分類標準有待完善。
[Abstract]:Background: psoriasis is a common clinical disease, its etiology and pathogenesis are not clear, its clinical manifestations are complicated and varied, the disease varies greatly, the severe patients have disability, and there is no safe and effective radical cure. Some of the patients were misdiagnosed because their early manifestations were atypical, so it posed a serious threat to their physical and mental health. Objective: to understand the clinical features of psoriasis of arthropathy and to improve the understanding of this disease. Methods: from March 2012 to September 2016, 78 patients with psoriasis of arthropathy were collected from Department of Dermatology and Rheumatological Immunology, second Hospital of Lanzhou University, including general information, initial symptoms and time, clinical features, and complicated diseases. Laboratory examination, imaging examination and treatment, diagnostic criteria were selected and analyzed by social science statistical software package 21.0. Results among the 78 patients, 47 were male (60.25) and 31 were female (39.74). The ratio of male to female was 1.5: 1. The age of the patients was 8 to 73 years old, the average age of skin lesions was 27.85 鹵10.95 years old, and the average age of arthritis was 37.72 鹵13.12 years old. The average interval from psoriatic lesions to joint involvement was 11 years. The symptoms of skin lesions were first found in 65 cases (83.33), joint symptoms in 6 cases (7.69%) and symptoms in 7 cases (8.97%) at the same time. There were 71 cases of psoriasis vulgaris, 6 cases of pustular psoriasis, 1 case of erythroderma psoriasis and 1 case of erythroderma psoriasis, among which there were 71 cases of psoriasis vulgaris, 6 cases of pustular psoriasis and 1 case of erythroderma psoriasis. In the clinical classification, there were 30.77 cases of spondyloarthropathy, followed by distal finger (toe) arthritis (26.92 cases), asymmetric arthritic type (20.51 cases), symmetrical polyarthritis type (11.54%) and residual destructive arthritis type (10.2626 8 cases). Thirty male (71.43) male patients with P0.05 or HLA-B27 positive for nail lesion of finger (toe) were more likely to present HLA-B27 in the central axial joint than in the peripheral joint (P0.05). RF positive patients could still be diagnosed as psoriasis. X ray CT scan was common in the diagnosis of psoriasis arthropathy in 30 male patients (71.43%), and the incidence rate of HLA-B27 was higher than that of peripheral joint (P0.05). RF positive patients could still be diagnosed as psoriasis of arthropathy. The change has a narrowing of the joint space, Some unusual imaging changes such as bone spines bone fusion or subluxation bone erosion and residual joint damage can also be seen. Ultrasound showed synovial hyperplasia, thickening, joint cavity effusion, bone erosion, attachment point inflammation, tenosynovitis, bursitis. Conclusion: in this study, the number of patients with psoriasis of arthropathy is slightly more than that of female, the lesion of psoriasis is earlier than that of PsA of arthritis, the lesion of psoriasis vulgaris is more than that of psoriasis vulgaris, the psoriasis of arthropathy can involve almost every joint of the whole body. The positive rate of HLA-B27 was significantly higher in the central axis joint than that in the peripheral joint in the PsA patients with the most frequent involvement, and was significantly higher than that in the female patients with psoriasis arthropathy. The diagnosis of psoriasis of arthropathy can not be completely excluded by RF positive of nail lesion in male patients. The clinical classification changes with the course of disease or time, and the existing diagnostic classification criteria need to be improved.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R758.63

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