甲基泼尼松龙联合免疫抑制剂治疗天疱疮

采用甲基泼尼松龙联合环磷酰胺、雷公藤多甙或甲氨喋呤治疗7例天疱疮。除1例91岁患者,治疗前即合并双下肺炎死亡之外,其余6例治疗均获成功。治疗2～11天无新疱出现,16～27天皮疹全部消退。无新疱出现所需皮质类固醇量相当于泼尼松50～120mg/d(平均77.5±27.9mg/d)。皮疹全部消退所需泼尼松相当量为890～6212.5mg(平均2128.8±2045.0mg)。未见严重副作用。结果表明甲基泼尼松龙联合免疫抑制剂治疗天疱疮,见效快,皮质类固醇用量小,皮疹全消时间短,安全性好。     

他汀药物治疗与脓毒症患者预后的相关性研究

目的探讨他汀药物治疗对脓毒症患者预后的影响。方法采用回顾性队列研究方法,选取河北联合大学附属开滦总医院重症监护病房（ICU）收治的脓毒症患者156例为研究对象。入选患者按是否服用过他汀类药物分为他汀治疗组与非他汀治疗组。建立数据库,收集入选患者的相关资料。对脓毒症患者死亡的危险因素进行Logistic回归分析。结果他汀治疗组脓毒症患者病死率低于非他汀治疗组病死率,30．43％VS48．18％,P〈0．05;多因素Logistic回归分析显示他汀药物为脓毒症患者死亡的保护因素,OR=0．471,95％CI0．227—0．977,P〈0．05;年龄〉60岁,OR=2．234,95％CI1．005—4．964,P〈0．05;APACHEII的评分〉22分,OR=4．633,95％CI1．689-12．708,P〈0．05,为脓毒症患者死亡的危险因素。结论他汀类药物对脓毒症患者可能有潜在保护性作用,能够降低脓毒症患者的病死率;高龄及高APACHEII评分是脓毒症患者死亡的危险因素。     

Treatment of aphthosis with thalidomide and with colchicine

Thalidomide alone (200-300 mg daily) or associated with colchicine (2-3 mg daily) was given orally to 25 patients with aphthosis: 8 patients with recurrent oral aphthae; 4 patients with recurrent mucocutaneous aphthosis, without visceral involvement, and 13 patients with Beh?et's disease (Touraine's aphthosis). A major improvement was noted in all groups, with a rapid healing of mucous lesions and a rapid reduction of pain and burning as compared to prior spontaneous regressions. No new outbreaks were noted at a dose of 50-100 mg thalidomide and 1 mg colchicine daily. Under oral administration of the drugs, thrombophlebitis was noted in 1 case (third group) only. In the other patients with Beh?et's disease, skin aphthae, ocular symptoms, arthritis, superficial nodular phlebitis quickly disappeared with treatment. The efficiency of the drugs is only temporary, since new lesions usually appeared a few weeks after the end of treatment. Due to the relatively small number of cases studied in each group, no conclusions can be drawn concerning the efficiency of thalidomide alone compared to the association of the two drugs. However, this open trial does support the usefulness of thalidomide, or thalidomide and colchicine, in recurrent mucocutaneous aphthae, aphthosis and Beh?et's disease.     

糖皮质激素联合免疫球蛋白治疗中毒性表皮坏死松解症15例疗效观察

目的:探讨糖皮质激素联合静脉注射免疫球蛋白(IVIG)治疗中毒性表皮坏死松解症(TEN)的临床疗效、不良反应和转归。方法:回顾性分析15例TEN患者采用糖皮质激素联合免疫球蛋白治疗的临床资料。结果:15例TEN患者均伴有黏膜糜烂,皮损(表皮已剥脱或即将剥脱)面积占体表面积的(19.40±6.51)％;糖皮质激素用量(以泼尼松为标准量):(1.5～2.0)mg/(kg·d);IVIG用量:(0.2～0.4)g/(kg·d),连续用药(6.0±1.3)d。联合用药第(3.0±1.3)天开始起效,痊愈9例,共治疗(23.60±5.49)d;基本痊愈5例,共治疗(16.70±3.14)d;死亡1例。所有患者均可耐受IVIG治疗。结论:糖皮质激素联合IVIG治疗TEN具有协同作用,可明显提高疗效和减少死亡,减少糖皮质激素引起的不良反应。     

43例HIV合并梅毒感染临床及脑脊液分析

目的：分析HIV合并梅毒的临床表现及实验室特征。方法：回顾性分析2014年3月至2017年7月在我院皮肤科进行腰穿的HIV合并梅毒感染的43例患者的人口学特点、临床表现及实验室检查。结果：43例患者中男39例,女4例,中位年龄为31.5岁。有3例（7.0%）符合神经梅毒诊断（脑脊液表现为白细胞≥20/μL并伴有脑脊液RPR阳性）。这3例患者均为二期梅毒,临床表现均为眼部症状,CD4均＜350个/μL,血清RPR均≥1:32。结论：在HIV合并梅毒感染时,神经梅毒尤其好发于血清RPR≥1:32,CD4＜350个/μL的二期梅毒患者。     

Nevus of ota with nevus of Ito--report of a case with cataract

A 53-year-old Japanese male patient with both nevus of Ota and nevus of Ito developed cataract of the eye ipsilateral to the side of the nevi. In this patient, cataract might have appeared in a close pathogenetic relationship with nevus of Ota.     

Clinical analysis of patients with dermatomyositis complicated with malignancies

目的:探讨皮肌炎(DM)并发恶性肿瘤的临床特点及实验室指标的变化.方法:对216例DM患者的临床表现及实验室指标进行回顾性分析.结果:DM患者恶性肿瘤的检出率为11.52%,且男性(22.22%)多于女性(7.43%)(P ＜ 0.01),并发肿瘤的DM患者平均发病年龄[(59.20±12.47)岁]大于未检出肿瘤患者[(47.20±14.40)岁].年龄＞40岁DM患者的恶性肿瘤检出率高.以DM为首发最终确诊为恶性肿瘤的患者中,DM病程＜1年的患者占94.44%.并发恶性肿瘤的DM患者皮肤异色样改变、吞咽困难和血沉增快等症状均高于未检出肿瘤患者.在并发恶性肿瘤的DM患者中,肿瘤先行发生者为16%、同时发生者占72%、后续发生者12%.结论:年龄＞40岁的男性DM患者,尤其伴有皮肤异色样改变、吞咽困难和血沉增快者易并发恶性肿瘤.     

Treatment of melasma with a depigmentation cream determined with colorimetry

Abstract

Background. Melasma is a pigmentary disorder often recalcitrant to treatment. Few studies have objectively evaluated the efficacy of treatment colorimetrically. Aim. To evaluate the safety and efficacy of a depigmentation cream, including mainly glycolic acid and Rumex occidentalis. Method. Twenty-seven patients applied the cream twice daily for the first 3 months and twice weekly for the following 3 months. L*, C* and h* values of the target lesions and the perilesional area were analyzed at baseline, 12 and 24 weeks colorimetrically. The physician and patient evaluated the clinical response rate. These results were compared statistically between the lesional and perilesional area. Results. There was a significant difference between 0–12, 0–24 (L*, C* and h* values) and 12–24 weeks (L* value) (p <0.001). For C* and h* values, the difference was not significant between 12 and 24 weeks (p = 0.464 and 0.151, respectively). Statistical significance was detected only between 3 and 6 months for C* value (p < 0.05) for the lesional and the perilesional areas. Clinical response rate was significant (p < 0.05). Conclusion. Our depigmentation cream is a moderate effective agent, well tolerated and can be considered as an alternative treatment of melasma. Twice-daily application may enhance the efficacy of treatment instead of twice-weekly application in the maintenance period.