【摘要】：目的：探討泛發(fā)型膿皰型銀屑病的病因、誘發(fā)和加重因素、臨床表現(xiàn)、相關實驗室檢查及治療方案,為臨床診斷及治療提供參考。 方法：收集整理山東大學齊魯醫(yī)院皮膚科2005年～2012年住院治療的53例GPP患者的病歷資料,對其此次發(fā)病因素、臨床表現(xiàn)、實驗室相關檢查、治療方法等進行回顧性分析,借助計算機SPSS17.0次件,應用t檢驗、方差分析等對臨床資料進行統(tǒng)計學分析。 結果：(1)53例病例中.實際患者為42人,有11人因疾病反復發(fā)作而數(shù)次入院(2～4次)。男22人,女20人,男：女=1.1：1,平均年齡27.98±17.6歲(2～65歲)；PSO-患者初次發(fā)生膿皰型銀屑病的年齡24.7±14.87歲,PSO~+患者初次發(fā)生膿皰型銀屑病的年齡為35.75±15.65歲,兩者比較差異有統(tǒng)計意義(p0.01)；(2)有明確發(fā)病誘因者37例(69.8%),有上呼吸道感染史14例(26.5%),用藥不當9例(17.0%)；生活事件5例(9.4%)；外傷5例(9.4%),內(nèi)分泌因素4例(7.5%)；無明顯誘因者16例(30.2%)。合并感染的14例GPP患者與無明顯誘因者的16例GPP患者入院體溫、WBC計數(shù)及膿皰消退時間比較差異有統(tǒng)計學意義；37例(69.8%)發(fā)病于春冬季節(jié),余16例(30.2%)發(fā)病于夏秋季節(jié)；(3)全身驟起膿皰14例,皮疹初發(fā)于頭面部6例,四肢11例,軀干17例,褶皺部位4例,有1例起于一指(趾)；皮疹多全身泛發(fā),多為針尖大小的膿皰,部分(41.5%)融合成“膿湖”。19例(35.8%)患者入院時有皮膚觸痛；6例(11.3%)患者出現(xiàn)關節(jié)酸脹、疼痛癥狀；溝紋舌8例(15.1%)；(4)實驗室檢查膿皰型銀屑病患者WBC、N%及血清鈣、血清白蛋白、總蛋白治療前后比較差異有統(tǒng)計學意義；(5)不同組合的藥物治療膿皰消退時間不同。 結論：(1)泛發(fā)型膿皰型銀屑病可發(fā)生于任何年齡,男女均罹患,且pso-的GPP發(fā)病年齡較pso+的GPP早；(2)膿皰型銀屑病好發(fā)于春冬季節(jié)；有多種誘發(fā)因素,尤以感染因素常見,且能加重病情,給予抗生素治療有利于病情恢復；(3)WBC計數(shù)、血清鈣及白蛋白可作為評估病情及轉(zhuǎn)歸的重要參考指標；(4)目前阿維A和MTX仍為GPP一線用藥,首選阿維A,病情嚴重者可酌情聯(lián)合應用糖皮質(zhì)激素、類激素藥物等。
[Abstract]:Objective: to investigate the etiology, inducing and exacerbation factors, clinical manifestations, laboratory examination and treatment of generalized pustular psoriasis, in order to provide reference for clinical diagnosis and treatment. Methods: the medical records of 53 GPP patients hospitalized in the Department of Dermatology, Qilu Hospital, Shandong University from 2005 to 2012 were collected and analyzed retrospectively. With the help of computer SPSS17.0, t-test and ANOVA were used to analyze the clinical data. Results: (1) 53 cases. The actual number of patients was 42, 11 patients were admitted several times due to recurrent attacks (24 times). 22 males and 20 females, male: female = 1.1: 1, mean age 27.98 鹵17.6 years (2.65 years), the age of first onset of pustular psoriasis in PSO- patients was 24.7 鹵14.87 years old, the age of PSO~ patients with pustular psoriasis was 35.75 鹵15.65 years old, the difference was statistically significant (p0.01). (2) there were 37 cases (69.8%) with definite inducement, 14 cases (26.5%) with history of upper respiratory tract infection, 9 cases (17.0%) with improper medication, 5 cases (9.4%) with life events, 5 cases (9.4%) with trauma, 4 cases (7.5%) with endocrine factors, and 16 cases (30.2%) with no obvious inducement. There were significant differences in body temperature, WBC count and pustular extinction time between 14 GPP patients with infection and 16 GPP patients without obvious inducement, 37 cases (69.8%) were in spring and winter season, the remaining 16 cases (30.2%) occurred in summer and autumn seasons. (3) there were 14 cases of systemic pustules, 6 cases of skin rash, 11 cases of extremities, 17 cases of trunk, 4 cases of fold, and 1 case originated from one finger (toe). 19 patients (35.8%) had skin tenderness on admission, 6 patients (11.3%) had joint acidosis and pain symptoms, 8 patients (15.1%); (4) with sulcus tongue had WBC,N% and serum calcium and serum albumin in the laboratory examination of pustule psoriasis. Total protein before and after treatment has statistical significance; (5) different combinations of drug treatment pustular extinction time is different. Conclusion: (1) Psoriasis may occur at any age, both male and female, and the onset of GPP in pso- is earlier than that of GPP in pso, (2) Psoriasis is prone to occur in spring and winter, and there are a variety of predisposing factors, especially infection factors. (3) WBC count, serum calcium and albumin can be used as an important reference index to evaluate the state of illness and prognosis. (4) Avera and MTX are still first-line drugs for GPP. Avera is the first choice, serious patients can use glucocorticoid, hormone-like drugs and so on.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R758.63

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