本文選題：天皰瘡 + 預(yù)后　； 參考：《廣西醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的:了解本地區(qū)天皰瘡患者的長期生存率,評(píng)估各相關(guān)參數(shù)與病人預(yù)后的關(guān)系,探索影響天皰瘡患者長期存活的相關(guān)因素,為今后制定合理的治療方案,提高療效,降低死亡率提供參考依據(jù)。 方法:采用回顧性分析方法,選擇廣西醫(yī)科大學(xué)一附院2001年1月1日到2008年12月30日期間首次住院確診的113例資料完整的天皰瘡患者,查閱其病歷資料,并通過電話咨詢的方式對(duì)患者或家屬進(jìn)行調(diào)查,獲得的隨訪資料用Microsoft Acess軟件建立個(gè)人資料庫。以天皰瘡患者確診日期作為觀察起點(diǎn),至患者死亡、失訪或最近一次隨訪時(shí)間為隨訪終點(diǎn)。截尾數(shù)據(jù)確定標(biāo)準(zhǔn):1,觀察期滿仍存活;2,失訪;3,死亡原因不是由于天皰瘡。整個(gè)隨訪工作于2010年2月4日終止。研究因素為臨床表現(xiàn),相關(guān)實(shí)驗(yàn)室結(jié)果,治療及預(yù)后,死亡原因等。采用SPSS13.0統(tǒng)計(jì)學(xué)軟件包進(jìn)行生存分析,采用方差分析和X2檢驗(yàn)對(duì)資料進(jìn)行描述性分析。生存曲線比較采用Kaplan-Meier法,Cox單因素分析及Cox多因素分析,對(duì)相關(guān)因素先用單因素Cox比例風(fēng)險(xiǎn)模型進(jìn)行分析,篩選出有統(tǒng)計(jì)學(xué)意義的因素再用多因素Cox比例風(fēng)險(xiǎn)模型進(jìn)行分析,P0.05為有統(tǒng)計(jì)學(xué)意義。 結(jié)果: 1.疾病狀況: 1.1一般情況:由于資料和患者搬遷等原因造成失訪者為23例,9年失訪率為20.2%。本組患者男女比例為1.02:1,發(fā)病年齡在11～79歲,平均年齡為46.12歲,50%患者年齡為40～60歲。天皰瘡所有類型中尋常型最常見(占82%);尋常型天皰瘡男女發(fā)病率基本相等,落葉型天皰瘡男性多于女性,皰疹樣天皰瘡女性多發(fā)。以口腔粘膜為首發(fā)部位的最多見,其次為軀干和頭面,首發(fā)部位為四肢者最少見。尋常型天皰瘡皮疹面積較其他類型天皰瘡大,粘膜損害者比例高,紅斑較少,P均0.05。 1.2實(shí)驗(yàn)室檢查:尋常型天皰瘡PLT升高較其他兩型天皰瘡明顯,尋常型天皰瘡與落葉型天皰瘡ALT升高及ALB下降較皰疹樣天皰瘡明顯,落葉型天皰瘡和皰疹樣天皰瘡患者UA升高較尋常型天皰瘡明顯,P均0.05。 1.3治療:尋常型天皰瘡和落葉型天皰瘡住院期間最大激素量較皰疹樣天皰瘡大,尋常型天皰瘡和落葉型天皰瘡患者病情較重,控制病情需要的激素量較皰疹樣天皰瘡多,P均0.05。 2. 113例天皰瘡患者生存率在前15個(gè)月時(shí)下降比較明顯,在15個(gè)月以后曲線下降較緩慢。 3.影響天皰瘡患者預(yù)后的單因素分析中,作用有統(tǒng)計(jì)學(xué)意義(P0.05)的變量為年齡,粘膜損害,感染,WBC、RBC、DBIL、ALT、AST結(jié)果,單獨(dú)使用激素,IgA結(jié)果。 4.多因素分析中,可能影響天皰瘡患者預(yù)后的指標(biāo)為ALT結(jié)果、RBC結(jié)果、單用激素治療、粘膜損害、年齡、感染等,其回歸系數(shù)均0,Exp(B)即危險(xiǎn)因素值均1,ALT升高、RBC減少、單用激素治療、合并粘膜損害、年齡大于60歲、有感染的患者預(yù)后不佳。 5.根據(jù)多因素分析的結(jié)果,擬合天皰瘡患者的生存模型為h(tx)=h0(t)exp(1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6);推導(dǎo)出預(yù)后指數(shù)PI=1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6)。 PI值越小,預(yù)后越好;PI值越大,預(yù)后越差。將2006年首次診斷天皰瘡患者的資料代入以上公式,并計(jì)算其PI值,結(jié)果顯示死亡的患者PI值較存活的患者大,P0.05。 結(jié)論: 1.尋常型天皰瘡和落葉型天皰瘡患者病情較重,控制病情需要的激素量較皰疹樣天皰瘡大。 2.不同類型天皰瘡存在部分實(shí)驗(yàn)室改變的差異:尋常型天皰瘡PLT升高較其他兩型天皰瘡明顯,尋常型天皰瘡與落葉型天皰瘡ALT升高及ALB下降較皰疹樣天皰瘡明顯,落葉型天皰瘡和皰疹樣天皰瘡患者UA升高較尋常型天皰瘡明顯。 3.天皰瘡確診后的前15個(gè)月內(nèi)死亡率較其他時(shí)段高。 4.ALT升高、RBC降低、單用激素、合并粘膜損害、年齡大、合并感染為影響天皰瘡患者生存率的獨(dú)立因素。存在這些因素的患者預(yù)后不好。 5.根據(jù)多因素分析的結(jié)果,擬合本地區(qū)天皰瘡患者的生存模型為hi(t)=h0(t)exp (1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6) 由此導(dǎo)出的預(yù)后指數(shù)PI=1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6)可以作為臨床有效預(yù)測(cè)天皰瘡預(yù)后的工具。
[Abstract]:Objective: to understand the long-term survival rate of pemphigus patients in the region, evaluate the relationship between the parameters of pemphigus and the prognosis of patients, explore the related factors that affect the long-term survival of pemphigus, and provide a reference for the formulation of reasonable treatment scheme, the improvement of the curative effect and the reduction of mortality.
Methods: 113 cases of pemphigus diagnosed in the first hospital of Guangxi Medical University from January 1, 2001 to December 30, 2008 were selected by retrospective analysis. The patient's medical records were consulted and the patients or family members were investigated by telephone consultation. The follow-up data were built by Microsoft Acess software. Set up a personal database. The date of the diagnosis of pemphigus as the starting point, to the patient's death, the loss of visits, or the last time of follow-up was the end point. The truncated data determined the standard: 1, the observation period was still alive; 2, the loss of visits, and 3, the cause of death was not due to pemphigus. The whole follow-up was terminated in February 4, 2010. The factors of the study were clinical, The results of the related laboratory, treatment and prognosis, the cause of death, etc. were analyzed by SPSS13.0 software package. The data were analyzed by variance analysis and X2 test. The survival curve was compared with Kaplan-Meier, Cox single factor analysis and Cox multifactor analysis, and the related factors were first used for the single factor Cox proportional risk model. The statistical analysis was carried out to screen out statistically significant factors and then analyzed by multivariate Cox proportional hazards model. P0.05 was statistically significant.
Result:
1. condition of disease:
1.1 general situation: 23 cases were lost because of data and patients' relocation, and the rate of loss of visits in 9 years was 1.02:1, the age of onset was 11~79 years, the average age was 46.12, the age of 50% patients was 40~60 years old. The most common (82%) of all types of pemphigus (pemphigus vulgaris), the incidence of male and female pemphigus vulgaris, was the basis of the incidence of pemphigus vulgaris. The same, deciduous pemphigus male more than women, herpes like pemphigus more women. The most common in the first part of the oral mucosa, the second is the trunk and the head, the first part of the extremities is the most rare. The area of pemphigus vulgaris is larger than other types of pemphigus, the proportion of mucous membrane damage is high, the erythema is less, P 0.05.
1.2 laboratory examination: the increase of PLT in pemphigus vulgaris was significantly higher than that of other type two pemphigus. The increase of ALT in pemphigus vulgaris and deciduous pemphigus and the decrease of ALB were more obvious than herpes like pemphigus. The elevation of UA in patients with deciduous pemphigus and herpes like pemphigus was more obvious than that of pemphigus vulgaris, P 0.05.
1.3 treatment: the largest amount of hormone in patients with pemphigus vulgaris and deciduous pemphigus was larger than herpes like pemphigus, and patients with pemphigus vulgaris and deciduous pemphigus were more serious. The amount of hormone needed to control the disease was more than that of herpes like pemphigus, and P was 0.05.
The survival rate of 2.113 patients with pemphigus decreased significantly in the first 15 months, and decreased slowly after 15 months.
3. in a single factor analysis of the prognosis of pemphigus patients, the variables of statistical significance (P0.05) were age, mucous membrane damage, infection, WBC, RBC, DBIL, ALT, AST results, and the use of hormone and IgA results alone.
In the 4. multivariate analysis, the prognostic indicators of pemphigus patients were ALT results, RBC results, single hormone therapy, mucosal lesion, age, infection, and so on. The regression coefficient was 0, Exp (B) was 1 of the risk factors, ALT increased, RBC decreased, the single use of hormone treatment, mucous membrane damage, age more than 60 years, and the poor prognosis of the infected patients.
5. according to the results of multifactor analysis, the survival model of pemphigus was fitted to h (TX) =h0 (T) exp (1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6) and prognostic index PI=1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6).
The smaller the PI value, the better the prognosis; the greater the PI value, the worse the prognosis. The data of the first diagnosis of pemphigus in 2006 were replaced by the above formula, and the PI value was calculated. The results showed that the PI value of the dead patients was larger than that of the surviving patients, P0.05.
Conclusion:
1. patients with pemphigus vulgaris and pemphigus vulgaris are more severe. The amount of hormone required to control the disease is larger than that of herpes like pemphigus.
2. different types of pemphigus in different types of pemphigus showed that the elevation of PLT in pemphigus vulgaris was significantly higher than that of other type two pemphigus, and that of pemphigus vulgaris with pemphigus vulgaris and deciduous pemphigus was significantly higher than that of herpes like pemphigus, and the increase of UA in deciduous pemphigus and herpes like pemphigus was significantly higher than that of pemphigus vulgaris in patients with defoliate pemphigus and herpes like pemphigus.
The mortality in the first 15 months after 3. days of diagnosis was higher than that in other periods.
4.ALT increased, RBC decreased, single use of hormones, mucous membrane damage, age, and infection were independent factors affecting the survival rate of pemphigus. These factors were not good for patients.
5. according to the results of multivariate analysis, the survival model of patients with pemphigus in this area is hi (T) =h0 (T) exp (1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6).
The derived prognostic index PI=1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6) can be used as a tool for predicting the prognosis of pemphigus clinically.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R758.66

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