甲真菌病危险因素的病例对照研究

目的探讨甲真菌病发病可能的危险因素。方法对175例甲真菌病患者进行1∶1配比的病例对照研究,采用单因素和多因素的条件Logistic回归分析。结果甲真菌病发病与下列9个因素密切相关:足癣(OR=10.502),手癣(OR=9.991),长期用广谱抗生素、皮质类固醇、免疫抑制剂治疗(OR=7.180),潮湿的生活或工作环境(OR=5.167),家族史(OR=2.687),甲外伤(OR=2.668),公用拖鞋、擦脚布、脚盆(OR=2.081),手足多汗(OR=1.955)、勤换鞋袜(OR=0.324)。结论足癣,手癣,长期用广谱抗生素、皮质类固醇、免疫抑制剂治疗,潮湿的生活或工作环境,家族史,甲外伤,公用拖鞋、擦脚布、脚盆,手足多汗是甲真菌病发病的危险因素,勤换鞋袜为甲真菌病的保护因素。     

深圳地区黄褐斑发病因素的流行病学调查

<正>对200例黄褐斑患者进行病例对照研究,并对相关危险因素进行多因素分析。结果:年龄、家族史、季节变化、精神(劳累)、日光照射、妊娠、敏感性皮肤为黄褐斑的危险因素,其OR值依次为0.131,1.650,12.995,0.269,36.460,78.075,14.695。防晒为黄褐斑的保护因素,其OR值为0.101。认为年龄、家族史、季节变化、精神(劳     

深圳地区黄褐斑发病因素的流行病学调查

目的探讨影响黄褐斑患病的危险因素,为制定黄褐斑干预策略,采取有针对性的防治措施提供科学依据。方法对深圳市人民医院就诊的200例黄褐斑患者进行病例对照研究,并对相关危险因素进行多因素分析。结果年龄、家族史、季节变化、精神(劳累)、日光照射、妊娠、敏感性皮肤为黄褐斑的危险因素,其OR值依次为0.131,1.650,12.995,0.269,36.460,78.075,14.695。防晒为黄褐斑的保护因素,其OR值为0.101。结论通过对本次流行病学调查,发现年龄、家族史、季节变化、精神(劳累)、日光照射、妊娠、敏感性皮肤是深圳地区黄褐斑发生的危险因素,防晒、心情愉悦为黄褐斑保护因素。而睡眠质量、睡眠不足、节育方式、化妆品因素与黄褐斑的发生无明显相关性。     

白癜风危险因素1∶1配比病例对照研究

目的　探讨影响白癜风发病环境中可能的危险因素。方法　运用 1∶1配比病例对照研究方法 ,使用单因素Logistic回归分析和多因素条件Logistic回归模型进行分析。结果　单因素分析结果显示 :饮酒 (OR =2 99)、精神紧张 (OR =2 19)、饮食不规律 (OR =4 3 7)、喜食辛辣 (OR =3 83 )、外伤 (OR =2 5 8)、经常接触农药 (OR =3 2 1)、接触油漆原料 (OR =3 0 2 )与白癜风发病呈正相关 ,适度阳光照射 (OR =0 81)、常吃蔬菜水果 (OR =0 72 )呈负相关 ;多因素条件Logistic回归模型分析表明饮酒 (OR =3 985 )、精神紧张 (OR =4 19)、喜食辛辣 (OR =5 83 )、外伤 (OR =1 73 )是白癜风发病危险因素 ,适度阳光照射 (OR =0 71)是一种负面因素。结论　饮酒、精神紧张、喜食辛辣、外伤是白癜风发病潜在环境危险因素 ,适度阳光照射则是一种负面因素     

吸烟、饮酒与银屑病病情及中医证型的相关性分析

目的探讨吸烟、饮酒与寻常性银屑病患者的疾病严重程度及中医辨证分型的相关性。方法制定统一调查表,临床中医医生填写寻常性银屑病患者吸烟和饮酒的情况,并对该患者进行辨证分型、皮损面积和病情严重程度指数(PASI)评分,通过χ2检验评价吸烟、饮酒与银屑病患者辨证分型和疾病严重程度的相关性。结果吸烟和饮酒在男性患者中的发生率分别为24.46倍和12.97倍于女性患者(P=0.00);男性患者的病情重于女性患者(P=0.00)。男性患者吸烟与疾病严重程度相关(P<0.05),病情越重,吸烟患者的比例越大;男性患者饮酒、女性患者吸烟和饮酒与病情严重程度均不相关(P>0.05)。寻常性银屑病的辨证以血热证、血燥证和血瘀证为主,占88.32%。吸烟的患者较不吸烟的患者更易出现血瘀证(OR=1.412),而不易出现血燥证(OR=0.795);更易出现挟毒证(OR=1.663),而不易出现挟湿证(OR=0.734)。饮酒的银屑病患者较不饮酒的患者更易出现血瘀证(OR=1.433),而不易出现血燥证(OR=0.763)。结论男性患者吸烟与银屑病病情严重度相关,吸烟和饮酒的患者更易出现难治的血瘀证,应当积极引导患者戒烟、戒酒。     

中国已婚妇女宫颈癌发病相关影响因素Meta分析

目的:利用Meta分析的方法探讨中国已婚妇女宫颈癌发病相关因素。方法:依据询证医学要求对相关医学数据库进行全面检索,将中国已婚妇女宫颈癌的病例对照研究筛选出来,对纳入研究的质量进行评价,然后对其进行Meta分析。结果:宫颈癌发病的危险因素的合并OR值及其95%CI为:首次性交年龄1.91(1.23,2.97)、首次怀孕年龄2.90(1.33,6.30)、结婚次数4.34(2.18,8.64)、孕次2.40(1.26,4.56)、HPV25.49(4.23,153.75)、经济收入5.88(0.23,147.64)、初潮年龄10.52(0.56,196.54)、肿瘤家族史5.06(2.70,9.51)及吸烟2.36(1.64,3.37)。结论:本研究综合发现,首次性交年龄、首次怀孕年龄、结婚次数、孕次、HPV、经济收入、初潮年龄、肿瘤家族史及吸烟均为宫颈癌发病相关影响因素。     

寻常性银屑病发病诱因分析

目的研究寻常性银屑病患者的发病诱因。方法采用问卷调查的方式,应用SPSS13.0统计软件对209例寻常性银屑病患者和191例健康对照进行银屑病致病诱因的多因素logistic回归分析。结果寻常性银屑病患者多因素logistic回归分析显示环境潮湿(OR=3.954 4)、感染(OR=4.158 5)、精神紧张(OR=3.394 0)、吸烟(OR=4.155 1)、嗜酒(OR=2.905 7)、染发(OR=3.390 0)、手术和外伤(OR=3.380 4)、睡眠差(OR=3.402 7)、遗传(OR=4.702 3)对寻常性银屑病的发病有显著影响(P0.001)。结论环境潮湿、感染、精神紧张、吸烟、嗜酒、染发、手术和外伤、睡眠差、遗传可能对寻常型银屑病发病起一定作用。     

有无家族史银屑病环境因素与HLA-DQA1等位基因交互作用的研究

目的　研究银屑病环境危险因素与HLA DQA1等位基因交互作用。方法　采用病例 对照方法调查 176例银屑病患者及 185例健康人环境因素 ,用PCR SSP方法检测HLA DQA1等位基因 ;对环境危险因素与HLA DQA1等位基因交互作用进行研究。结果　①在有及无家族史银屑病中 ,HLA DQA1 0 10 4与受潮存在交互作用 (P <0 .0 5 ,OR>4.0 ) ;在无家族史银屑病中HLA DQA1 0 10 4与饮酒 (P =0 .0 190 ,OR =4.62 )、食鱼虾 (P =0 .0 42 6,OR =2 .82 )存在交互作用。②HLA DQA1 0 2 0 1与食鱼虾 (P =0 .0 0 74,OR =4.72 )仅在无家族史银屑病中存在交互作用。③HLA DQA1 0 5 0 1与受潮 (P =0 .0 0 40 ,OR =10 .5 0 )、食鱼虾 (P =0 .0 3 3 8,OR =5 .41)和精神紧张 (P =0 .0 482 ,OR =8.14 )仅在有家族史银屑病中存在交互作用。结论　HLA DQA1等位基因能增加银屑病环境危险因素发生该病的危险性 ,在有及无家族史银屑病中存在差异。     

婴儿湿疹发病相关危险因素调查分析

目的探讨兰州地区婴儿湿疹发病相关危险因素,为预防和控制兰州地区婴儿湿疹发病提供科学依据。方法采用问卷调查方式,收集就诊于兰州大学第一医院皮肤性病科及儿童保健中心的婴儿湿疹患儿及健康婴儿的生产史及抚养方式、家族过敏史、室内居住环境等64项相关信息。对所获数据进行统计分析。结果纳入研究组的湿疹患儿86例,对照组健康婴儿84例。两组一般和基线资料经统计学检验差异无统计学意义。在父母社会人口学特征中,家庭居住地不同(P=0. 032)、与婴儿同住家庭人口数(2人、3人、4人及以上)(P=0. 009; P=0. 045)差异有统计学意义;在父母行为方式中,患儿父亲吸烟暴露(P=0. 047)差异有统计学意义;在遗传背景因素中,父亲患有过敏性疾病(χ~2=4. 582,P=0. 032),差异有统计学意义。结论家庭居住地在城市、与婴儿同住家庭人口数增加、患儿父亲吸烟暴露、父亲患过敏性疾病提示为兰州地区婴儿湿疹发病的相关危险因素。     

天津市婴儿过敏性疾病影响因素病例对照研究

目的探讨天津地区婴儿过敏性疾病发生情况及其相关危险因素,为今后儿童过敏性疾病的防治工作提供一定的理论依据。方法采用问卷调查就诊于天津市妇女儿童保健中心筛查门诊的婴儿过敏情况,对收集的数据进行统计分析。结果纳入病例组婴儿701例,对照组婴儿516例,两组在一般情况上差异无统计学意义(P0.05)。婴儿家长报告儿童过敏性疾病的发生比例为57.60%。结果显示,两组婴儿在母孕期服药史、母孕期常使用消毒剂或驱蚊剂、母孕期服用复合维生素、母孕期服用钙剂、母孕期服用益生菌、婴儿父亲有过敏性疾病、婴儿母亲有过敏性疾病、婴儿分娩方式、婴儿接触毛绒玩具、婴儿常使用清洁用品、婴儿服药史、婴儿喂养方式等方面差异具有统计学意义(P0.05)。回归分析显示母孕期服药史(OR=1.31)、婴儿母亲有过敏性疾病(OR=1.97)、婴儿剖宫产(OR=1.47)、婴儿接触毛绒玩具(OR=1.43)、婴儿常使用清洁用品(OR=1.54)、婴儿服药史(OR=2.44)是过敏性疾病发生的危险因素;母孕期服用复合维生素(OR=1.36)、母孕期服用益生菌(OR=1.36)是过敏性疾病发生的保护因素。结论普及过敏科普知识,加大宣传力度,减少孕期和婴儿期相关危险因素的暴露,可预防过敏性疾病的发生。     

Polymorphic light eruption may be associated with cigarette smoking and alcohol consumption

BACKGROUND: Although the genetic influence on polymorphic light eruption (PLE) is well established, the role of lifestyle factors is less well defined. METHODS: A retrospective case-control study was conducted that included 74 PLE patients and 102 controls. Each participant was interviewed about demographic, disease and lifestyle characteristics such as smoking, alcohol consumption and use of medications. Multivariate logistic regression models were used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Compared with the controls, patients with PLE were significantly more likely to be younger females (P<0.05). Univariate analysis did not show a significant association between any of the smoking-related questions and PLE. However, after adjusting for gender and drinking alcohol, patients with PLE were significantly more likely to smoke 15 cigarettes or more daily [adjusted OR=4.06 (95% CI=1.19, 13.80) compared with 0 daily cigarettes] than controls. Participants who consumed six or more drinks a week were less likely to have PLE [adjusted OR=0.24 (95% CI=0.07, 0.80)]. In contrast, women who used oral anticonceptives for a longer period were four-fold more likely to have PLE [adjusted OR=4.74 (95% CI=1.33, 16.86)]. CONCLUSION: Several lifestyle factors may be associated with PLE, but further studies are warranted to confirm these retrospective findings.     

多形性日光疹发病的免疫机制研究进展

多形性日光疹是特发性光线性皮肤病中最常见的一种,好发于中青年妇女.目前认为由紫外线诱发产生的抗原介导的免疫反应及迟发型超敏反应是发病的关键因素,但其具体病因学和发病机理仍然不清楚.本文就有关的免疫机制进行综述.     

The polymorphous light eruption–severity assessment score does not reliably predict the results of phototesting

Background Polymorphous light eruption (PLE) is a very common photodermatosis in which patient history is highly specific. Phototesting is used to confirm the diagnosis and to determine the action spectrum and the severity of this disease. In daily practice and in research studies, it would be convenient to assess disease severity by patient history only. Objectives This study aims to assess PLE disease severity via patient history and compares this with severity assessment via phototesting. Patients and methods Sixty‐one patients with PLE were asked 10 standard questions and all were phototested. The answers to the standard questions were coded with linear scores ranging from 0 to 10. The score of each question was plotted as independent variable in a multiple linear regression model against the score of the phototest (minimal number of irradiations necessary to elicit a positive skin lesion, with a maximum of 6 irradiations) as dependent variable using an enter approach. Furthermore, the scores of the separate questions were added to form a total score, the PLE–severity assessment score (PLE‐SAS). The medians of these PLE‐SASs were compared with the result scores obtained by phototesting. Phototesting was done with ultraviolet A and ultraviolet B irradiation. Results Fifty‐seven of the 61 patients had a positive test result (93%). Using the multiple linear regression model, the severity assessment by patient history (PLE‐SAS) compared with the result of phototesting showed two significant contributing questions (adjusted PLE‐SAS) (P < 0.05) but with a regression coefficient of 0.2. A significant difference in median scores with the severity assessment (PLE‐SAS and adjusted PLE‐SAS) between patients testing positive after 1–3 irradiations compared with those testing positive after 4–6 irradiations was present (P < 0.05). However, the overlap quartile range between both groups was such that the PLE‐SAS and the adjusted PLE‐SAS have little predictive value in individual patients. Conclusions We showed that in PLE, disease severity as determined using the PLE‐SAS or adjusted PLE‐SAS did not reliably predict severity as assessed by phototesting. Two significant contributing questions were not discriminating enough to be used as predicting questions to assess severity. Accurate patient history proved to be a reliable method to diagnose PLE. Phototesting is useful to determine the responsible ultraviolet action spectrum and to exclude differential diagnoses like photosensitive eczema, lupus erythematosus or chronic actinic dermatitis. PLE‐SAS cannot replace phototesting for determining the severity of PLE.     

多形性日光疹的病因及发病机制研究进展

多形性日光疹是一种与日光照射有关的光敏性皮肤病,其病因及发病机制尚不清楚,可能与遗传因素、紫外线联合诱导机体内抗原、外源性光敏物及免疫功能紊乱有关.近年来,其病因及发病机制的相关报道逐渐增多,其中,主要与外界因素中波紫外线、长波紫外线的直接照射,自身氧自由基的增多,迟发型超敏反应,细胞因子及遗传因素相关,也有多形性日光疹向自身免疫性疾病发展的报道,因此,探索多形性日光疹的发病机制仍然是临床医师面临的重要课题.

Abstract：

Polymorphous light eruption (PLE) is a chronic, idiopathic, common photoreactive disease associated with sunlight exposure. The etiology and pathogenesis of PLE are still unclear, and reported to be associated with genetic factors, ultraviolet ray-induced internal antigens and external photosensitive materials,immune function disturbance, et al. Recently, there have been increasing reports on the etiology and pathogenesis of PLE, which are mainly related to the direct exposure to ultraviolet B and ultraviolet A,accumulation of oxygen free radicals, delayed type hypersensitivity, cytokines and inherent factors. Besides, the transition of PLE to autoimmune diseases has been reported. Nowadays, it is an important task for clinicians to clarify the pathogenesis of PLE.     

外阴阴道念珠菌病的危险因素分析

目的 探讨外阴阴道念珠菌病发病的危险因素.方法 使用专门设计的《外阴阴道念珠菌病的流行病学调查表》在3个研究中心调查156例外阴阴道念珠菌病患者和112名健康女性对照者,并通过单因素分析和多因素Logistic分析外阴阴道念珠菌病的危险因素.结果 单因素统计分析结果 提示:性伴患生殖器念珠菌病、经期性生活、合并其他性传播疾病、合并妊娠、口服避孕药、洗盆浴、心情抑郁、穿紧身裤、人工流产史为其危险因素.多因素Logistic分析结果 显示:性伴患生殖器念珠菌病、人工流产史、经期性生活、口服避孕药、合并其他性传播疾病、性伴不固定、使用宫内节育器、已婚、使用抗生素为本病的危险因素.结论 性伴患生殖器念珠菌病、人工流产史、经期性生活、口服避孕药、合并其他性传播疾病、性伴不固定是外阴阴道念珠菌病发病的主要危险因素(OR=2.01～9.77).     

影响银屑病预后的相关因素分析

目的探讨影响银屑病预后的相关因素。方法采用回顾性研究的方法,对350例住院银屑病患者的病历资料进行多因素非条件性Logistic回归分析。结果脂肪肝(P=0.0389,OR=2.244)对银屑病预后的影响有显著性(P<0.05),低蛋白血症(P=0.0005,OR=7.929)对银屑病预后的影响有高度显著性(P<0.01),高脂血症(P=0.0034,OR=0.211)成为银屑病预后的保护性因素,其影响有高度显著性(P<0.01),高尿酸血症(P=0.0858,OR=2.750)和特殊用药史(P=0.0658,OR=1.922)对银屑病预后的影响亦不容忽视。结论影响银屑病病情严重程度的因素主要为代谢系统紊乱,如脂肪肝、低蛋白血症、高尿酸血症,而高脂血症可能是银屑病的保护性因素。     

探讨依托孕烯皮下埋植后阴道不规则出血的危险因素Logistic回归研究

目的应用Logistic回归分析法分析依托孕烯皮下埋植后阴道不规则出血的危险因素。方法选取2017年6月至2018年6月在广州市红十字会医院接收的220例依托孕烯皮下埋植剂避孕的育龄期妇女作为研究对象。根据是否发生阴道不规则出血将其分为出血组和非出血组,应用单因素和多因素Logistic回归分析法明确导致阴道不规则出血的相关因素。结果 220例进行依托孕烯皮下埋植后阴道不规则出血发生率为31.82%。出血组和非出血组文化程度、避孕药服用史、痛经史、孕次、埋植时间及剖宫产史者构成比比较,差异均无统计学意义(P>0.05),与非出血组相比,出血组年龄<25岁、BMI<18.5 kg/m^2、有IUD应用史、流产≥3次者更多,埋植期非哺乳者构成比较高,差异均有统计学意义(P<0.05),且经Logistic回归分析发现均是导致依托孕烯皮下埋植后阴道不规则出血的危险因素(OR=3.673、2.440、2.898、2.683、2.487;P=0.003、0.000、0.000、0.000、0.003)。结论年龄<25岁、BMI<18.5 kg/m^2、有IUD应用史、流产次数≥3次、埋植期非哺乳均是导致依托孕烯皮下埋植后阴道不规则出血的危险因素,临床中应对存在上述危险因素者给予充分重视,合理选择避孕方式。     

Polymorphous light eruption and benign summer light eruption in Italy

Background/purpose: Polymorphous light eruption (PLE) heterogeneity has been postulated, but the existence of benign summer light eruption (BSLE) is controversial. We studied the prevalence of the clinical patterns, criteria distinguishing BSLE from PLE, and diagnostic usefulness of phototest. Methods: Five Italian Photodermatology Centres recruited retrospectively 346 patients with typical clinical history and/or presentation of PLE. Age, gender, skin type, family history and presence of atopy were considered. UVA and UVB MEDs and provocative phototests with UVA and UVB were obtained with a standardized procedure. Photopatch tests were applied according to the IRCDG rules. ANA were assessed by indirect immunofluorescence. Results: Four criteria (predominance of women, shorter latency, uninvolvement of the face and absence of relapse during summer) identified BSLE in only 6.1% of cases. All had positive phototests, mostly with UVA. Uninvolvement of face, short latency and no seasonal relapses identified 11.7% patients, mostly with positive phototests to UVA. Short latency and no seasonal relapses in women identified 11.2% patients. Uninvolvement of face and no seasonal relapses in women identified 8.1% of patients. Uninvolvement of face and short latency in women identified 17.6% of patients. Conclusion: Criteria diagnosed BSLE in only a minority of patients, who were positive at phototesting, mostly with UVA.     

Hepatitis C virus infection in a large cohort of homosexually active men: independent associations with HIV-1 infection and injecting drug use but not sexual behaviour.

OBJECTIVE: To determine the prevalence and risk factors for hepatitis C virus (HCV) infection in a cohort of homosexually active men, with particular reference to assessing sexual transmission. DESIGN: Prevalence based on cross-sectional testing for HCV (c100 protein) antibody in a cohort using sera stored between 1984 and 1989, and assessment of risk factors using a case-control analysis based on questionnaire data from HCV positive and negative subjects. SUBJECTS/SETTING: 1038 homosexually active men who were participating in a prospective study established to identify risk factors for AIDS. They had been recruited through private and public primary care and sexually transmissible disease (STD) services in central Sydney. MAIN OUTCOME MEASURES: Prevalence of HCV antibody and its association with human immunodeficiency virus type 1 (HIV-1) infection and other STDs, number of sexual partners, sexual practices and recreational drug use. RESULTS: Overall, 7.6% of subjects tested were seropositive for HCV antibody. In univariate analysis, HCV infection was significantly associated with injecting drug use (IDU) (OR = 8.18, p < 0.0001) and HIV infection (OR = 3.14, p < 0.0001) and with self reported history of syphilis (OR = 1.88, p = 0.016), anogenital herpes (OR = 1.93, p = 0.017), gonorrhoea (OR = 2.43, p = 0.009) and hepatitis B (OR = 1.92, p = 0.010). In case control analysis, similar sexual behaviours (partner numbers and practices) were reported by HCV positive and HCV negative subjects except that HCV negative subjects more frequently reported engaging than HCV positive subject in unprotected receptive anal intercourse without ejaculation (OR = 0.61, p = 0.034), unprotected insertive (OR = 0.59, p = 0.039) and receptive (OR = 0.56, p = 0.016) oro-anal intercourse (rimming) and insertive fisting (OR = 0.48, p = 0.034). In multiple logistic regression analyses, only HIV-1 infection (OR = 3.18, p < 0.0001) and IDU in the previous six months (OR = 7.24, p < 0.0001) remained significantly associated with the presence of HCV antibody. CONCLUSIONS: IDU was the major behavioural risk factor for HCV infection. If sexual or another from of transmission did occur, it may have been facilitated by concurrent HIV-1 infection.