头面部皮瓣修复术后并发症发生风险模型的构建

 目的 分析头面部皮瓣修复术后并发症发生的危险因素，并建立风险预测模型。方法 选择佛山市中医院2017年10月至2020年9月120例行皮瓣修复术患者，单因素和logistic多因素回归分析筛选术后并发症发生的危险因素，并建立个性化预测列线图模型。结果 术后并发症发生率为25.83%，其主要的并发症是组织瓣血管危象，其他有感染、皮瓣撕脱、皮下血肿及水肿等。经logistic多因素回归分析，静脉端侧吻合（OR=3.766，95%CI：1.587～8.938）、术中失血过多（OR=2.889，95%CI：1.089～7.668）、吸烟史（OR=4.697，95%CI：1.558～14.161）、医师手术水平（OR=3.062，95%CI：1.183～7.922）及皮瓣设计不当（OR=2.399，95%CI：0.861～6.686）是皮瓣修复术后并发症发生的危险因素（均P＜0.05）。基于以上危险因素建立风险列线图模型，C-index指数为0.829（95%CI：0.806~0.853），具有较好的精确度和区分度。结论 静脉端侧吻合、术中失血过多、吸烟史、医师手术水平及皮瓣设计不当是皮瓣修复术后并发症发生的危险因素，基于以上建立的风险模型预测精准度较高，对头面部皮瓣修复术后并发症的筛查具有较高的应用价值。     

培养的自体黑素细胞移植治疗伴自身免疫性甲状腺疾病的非节段型白癜风患者的疗效及安全性随访

【摘要】 目的 探讨培养的自体黑素细胞移植治疗伴自身免疫性甲状腺疾病的白癜风患者的临床疗效及安全性。方法 回顾2008年5月至2018年12月杭州市第三人民医院行培养的自体黑素细胞移植治疗的2 284例非节段型白癜风,其中伴自身免疫性甲状腺疾病75例,包括甲状腺功能亢进42例,甲状腺功能减退18例,桥本甲状腺炎15例。比较伴自身免疫性甲状腺疾病组与不伴自身免疫性甲状腺疾病组的疗效及安全性。计数资料的比较采用χ2检验。结果 2 284例患者中,男1 085例,女1 199例,年龄（25.0 ± 1.2）岁,病程（5.1 ± 2.3）年。术后6个月,2 209例不伴自身免疫性甲状腺疾病组中1 873例有效（84.8%）、1 162例痊愈（52.6%）;伴自身免疫性甲状腺疾病组46例有效（61.3%）、20例痊愈（26.7%）,伴自身免疫性甲状腺疾病组有效率及痊愈率均低于不伴自身免疫性甲状腺疾病组（χ2值分别为29.72、19.54,均P < 0.001）。甲状腺功能减退组有效率低于甲状腺功能亢进组（χ2 = 6.61,P = 0.010）。伴自身免疫性甲状腺疾病组供皮区同形反应发生率（9.3%）高于不伴自身免疫性甲状腺疾病组（4.3%,χ2 = 4.31,P = 0.038）,且移植部位1、3、5及10年白斑复发率（6.7%、14.7%、17.3%、8.7%）均高于不伴自身免疫性甲状腺疾病组（0.7%、1.4%、2.1%、3.6%,χ2值分别为29.96、70.69、67.23、41.61;均P < 0.001）。结论 伴发自身免疫性甲状腺疾病对于白癜风的自体黑素细胞移植治疗具有负相关效应,针对该类患者更应积极采取有效的预防同形反应和移植区复发的手段。     

1 125例非节段型白癜风皮损分布的相关因素分析

目的 分析非节段型白癜风皮损分布与性别、发病年龄、病程、自身免疫病病史或家族史、白癜风家族史等因素的相关性。方法 回顾性分析2009年1月至2019年1月在北京医院皮肤科确诊的1 125例非节段型白癜风患者的临床资料，应用SPSS 20.0软件通过独立样本t检验及χ2检验对数据进行统计学分析。结果 1 125例非节段型白癜风患者中，男599例，女526例，男女比例1.14∶1，发病年龄（27.9 ± 17.1）岁，病程（5.2 ± 8.0）年。皮损累及率最高的部位是躯干（544例，48.4%）和面部（535例，47.6%），其次是肢端（430例，38.2%）、四肢（297例，26.4%）和颈部（231例，20.5%）。599例男性口周（17.2%）、手部（47.9%）及外生殖器部位（14.5%）的受累率高于526例女性（9.7%、22.6%、6.3%，χ2值分别为13.33、77.66、20.01，均P＜0.001），而女性颈部（27.0%）的受累率则高于男性（14.9%，χ2 = 25.29，P＜0.001）。下肢、膝部、足部、躯干、外生殖器及眼周受累的白癜风患者发病年龄显著低于相应部位未受累者（均P＜0.05），而上肢和手部受累者发病年龄显著高于上述部位未受累者（均P＜0.05）。自身免疫性甲状腺病病史或家族史阳性的患者手部受累率（50.0%）高于阴性者（27.9%，χ2 = 6.62，P = 0.010）。有白癜风家族史者躯干受累率（59.6%）高于无白癜风家族史者（45.7%，χ2 = 13.36，P＜0.001）。结论 非节段型白癜风皮损的分布模式与性别、发病年龄、自身免疫病病史或家族史以及白癜风家族史等因素均有一定相关性。     

白癜风与自身免疫性甲状腺疾病的研究进展

临床流行病学研究发现,白癜风常伴发一些自身免疫性疾病,特别是自身免疫性甲状腺疾病.关于白癜风伴发自身免疫性甲状腺疾病已有许多的病例报道.相对于健康人群,白癜风患者中甲状腺相关抗体水平升高,伴发自身免疫性甲状腺疾病的白癜风患者往往患病年限长,皮损范围较大.白癜风患者体内Th17/Treg失衡,黑素细胞表达的相关蛋白被看作自身抗原,这些抗原有部分也表达于甲状腺组织,这是白癜风伴发自身免疫性甲状腺疾病的免疫基础.白癜风的易感基因位点有些与自身免疫疾病相关,这些位点是白癜风伴发自身免疫性甲状腺疾病的遗传因素.目前发现,-428T FoxD3变异与白癜风发生有密切关系,与抗TPO抗体及抗甲状腺球蛋白抗体升高相关.     

白癜风患者215例临床分析

目的：总结白癜风患者的临床特点和发病诱因.方法：对确诊的白癜风患者进行问卷设计和调查,用SPSS 11.5软件包进行统计分析.结果：资料完整的215例白癜风患者中男98例,女117例;平均发病年龄18.76±7.43岁;最常见的受累部位为上肢（54.42%）;伴发疾病中以甲状腺疾病最常见（5.58%）;有家族史者占13.02%,有家族史患者发病年龄为14.6±4.31岁,无家族史为25.09±5.45岁（P〈0.001）,两者间有显著性差异;春夏季发病最常见;25.58%的患者可发现诱因,其中常见的诱因包括精神因素 （43.64%）和皮肤损伤（56.36%）.结论：本地区白癜风好发于青少年,有家族史患者发病年龄早于无家族史患者,上肢为最常见的好发部位,可能与精神因素和皮肤外伤、日晒伤有关.     

白癜风并发自身免疫性甲状腺疾病的研究现状

白癜风常并发其他自身免疫性疾病,如自身免疫性甲状腺疾病(autoimmunne thyroid disease,AITD)、类风湿关节炎、1型糖尿病、恶性贫血、系统性红斑狼疮(systemic lupus erthematosus,SLE)、艾迪生病、斑秃等,其中以AITD最多见,包括Graves病、慢性淋巴细胞性甲状腺炎(桥本病)、亚急性甲状腺炎、甲状腺相关性眼病等,但有关白癜风并发AITD确切机制研究甚少。鉴于白癜风是一种多因素、多基因遗传性疾病,发病机制复杂,与遗传和各种非遗传因素相关,多数认为是由基因、环境和免疫系统的相互作用,导致共同的终末通路,即氧化应激-自身免疫介导的黑素细胞缺失,特别是非节段型白癜风(non-segmental vitiligo,NSV)。该文从白癜风的基因、自身免疫和氧化应激3个关联机制上综述、阐述其与AITD的关系。     

系统免疫炎症营养指数对老年腹腔镜前列腺癌根治术患者术后谵妄的预测价值

目的 探讨术前系统免疫炎症营养指数(SIINI)评价对老年腹腔镜下前列腺癌根治术(LRP)患者并发术后谵妄(POD)的预测价值。方法 选取2019年1月至2022年12月在海南医学院第二附属医院行LRP的657例老年患者作为研究对象。采用受试者工作特征(ROC)曲线分析术前SIINI评价对老年LRP患者并发POD的预测价值。采用单因素分析和多因素Logistic回归分析探讨术前SIINI与老年LRP患者并发POD的关系,并构建和评价基于术前SIINI的列线图预测模型。结果 老年LRP患者POD的发生率为16.59%(109/657)。经ROC曲线分析,术前SIINI预测老年LRP患者并发POD的效能高于中性粒细胞/淋巴细胞比值和预后营养指数。Logistic回归分析结果显示,年龄≥75岁、简易精神状态检查量表评分<27分、手术时间≥120 min、术中出血量≥600 mL、SIINI≥18.51是老年LRP患者并发POD的独立危险因素(P<0.05)。基于术前SIINI构建的列线图预测模型的一致性指数为0.895(95%CI:0.858～0.932),校准曲线斜率接近1,具...     

个体化预测腹腔镜胃癌术后小肠梗阻的列线图模型的建立

目的探讨腹腔镜胃癌术后小肠梗阻的危险因素,并建立预测腹腔镜胃癌术后小肠梗阻的列线图模型。方法选取2017年2月-2020年12月进入淮南东方医院集团总院进行诊治的258例行腹腔镜手术的胃癌患者作为研究对象,采用Logistic回归分析筛选腹腔镜胃癌术后小肠梗阻的危险因素,采用R(R3.5.3)建立预测腹腔镜胃癌术后小肠梗阻的风险列线图模型。结果所选258例行腹腔镜手术的胃癌患者中有39例患者术后发生小肠梗阻,小肠梗阻的发生率为15.12%(39/258)。Logistic回归分析结果显示,性别(女)、年龄≥60岁、腹部手术史、BMI>24 kg/m²、糖尿病及手术医生经验≤5年是腹腔镜胃癌术后小肠梗阻的危险因素(P<0.05)。列线图模型结果显示,模型一致性指数(C-index)为0.795(95%CI:0.749~0.842)校正曲线与理想曲线基本一致,受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线下面积(AUC)为0.781,决策曲线显示阈值概率在3%~83%时,具有较高的净获益值。结论性别、年龄≥60岁、腹部手术史、BMI>24 kg/m²、糖尿病及手术医生经验≤5年是腹腔镜胃癌术后小肠梗阻的危险因素,基于危险因素建立的列线图有助于预测腹腔镜胃癌术后小肠梗阻的发生风险。     

白癜风共病糖尿病风险预测模型的构建及验证

【摘要】 目的 分析白癜风共病糖尿病危险因素,并构建、验证预测模型。方法 110例白癜风共病糖尿病患者（共病组）及4 505例白癜风未共病糖尿病患者（对照组）来源于第四军医大学西京医院2010年1月至2021年9月的病历数据库,按照性别、年龄进行1∶4倾向性得分匹配。匹配完成后,按照4∶1随机划分为训练集和测试集。使用训练集通过logistic回归分析患者的人口学和临床特征,筛选差异因素,构建预测模型,使用五折交叉验证进行内部验证,并通过测试集进行区分度（曲线下面积,AUC）、校准度（Hosmer-Lemeshow检验）和准确性（灵敏度、特异度、阳性预测值、阴性预测值）评价。结果 共病组107例与对照组428例成功匹配,训练集430例,测试集105例。根据多因素logistic回归结果,预测模型纳入白癜风病程［比值比（OR） = 1.04,95%可信区间（CI）：1.02～1.07,P＜0.001］、高糖/高脂/高盐饮食（OR = 3.19,95% CI：1.38～7.38,P = 0.007）、糖尿病家族史（OR = 23.23,95% CI：9.72～55.50,P＜0.001）、代谢性合并症（OR = 12.53,95% CI：5.60～28.07,P＜0.001）、自身免疫性合并症（OR = 5.89,95% CI：2.52～13.76,P＜0.001）及肢端型白癜风（OR = 3.84,95% CI：1.45～10.19,P = 0.007）6个预测指标。五折交叉验证显示该模型预测效果良好,训练集AUC为 0.902（95% CI：0.864～0.940）,验证集AUC为 0.895（95% CI：0.815～0.974）。在测试集上应用构建的模型,评价结果显示其具有良好的区分度（AUC = 0.814,95% CI：0.715～0.913）、校准度（Hosmer-Lemeshow检验P = 0.068）及准确性（灵敏度 = 0.810,95% CI：0.574～0.937;特异度 = 0.786,95% CI：0.680～0.865;阳性预测值 = 0.486,95% CI：0.317～0.657;阴性预测值 = 0.943,95% CI：0.853～0.982）。结论 基于白癜风病程、肢端型白癜风、高糖/高脂/高盐饮食、糖尿病家族史、代谢性合并症和自身免疫性合并症6个预测指标构建的白癜风共病糖尿病风险预测模型具有较好的区分度、校准度及准确性,能够为筛查高危人群提供依据。     

经尿道前列腺切除术后并发导尿管相关膀胱刺激征的风险预测列线图模型构建研究

目的 探讨经尿道前列腺切除术(TURP)后并发导尿管相关膀胱刺激征(CRBD)的危险因素,并构建风险预测列线图模型。方法 回顾性分析2020年1月至2022年2月海南省人民医院收治的246例行TURP治疗的患者的临床资料。根据术后是否并发CRBD将其分为并发组(n=148)和未并发组(n=98)。分析TURP后并发CRBD的影响因素,并建立风险预测列线图模型。结果 TURP后并发CRBD的影响因素包括年龄>65岁、麻醉后留置导尿管、药物催醒、术后尿路感染、使用氯胺酮/艾司氯胺酮类药物、使用抗胆碱能药物(P<0.05);基于上述影响因素构建列线图模型,根据列线图低、中、高风险临界值分为TURP后并发CRBD低、中、高风险(<79.63分、79.63～160.23分、>160.23分);受试者工作特征(ROC)曲线分析显示,列线图预测TURP后并发CRBD的曲线下面积(AUC)为0.810(95%CI:0.756～0.857);采用Bootstrap自抽样法内部验证的一致性指数为0.798,该列线图模型区分度良好;校准曲线与标准曲线贴合较好。结论 年龄>65岁...     

白癜风与自身免疫性甲状腺疾病

白癜风的病因及发病机制尚未完全阐明,目前多认为自身免疫在白癜风的发病中占重要地位.近年来发现,白癜风常伴发其他自身免疫性疾病,如自身免疫性甲状腺疾病、胰岛素依赖型糖尿病、恶性贫血、Addison病、系统性红斑狼疮、炎性肠病等,其中以自身免疫性甲状腺疾病最多见.从易感基因、甲状腺自身抗体、甲状腺激素水平、CD4+CD25+调节性T细胞、氧化应激等方面就白癜风伴发自身免疫性甲状腺疾病的研究进展进行概述,进一步探讨白癜风与自身免疫性疾病的相关性.     

Relevance of autoimmune thyroiditis in children and adolescents with vitiligo

Background Vitiligo is the most common pigmentation‐related disorder worldwide. An autoimmune etiology is widely considered, and genetic factors may play an important role in its pathogenesis. The purpose of this study was to assess the incidence of thyroid dysfunctions and autoimmune thyroiditis in children with vitiligo and to identify related factors. Methods Fifty children with vitiligo and 50 control children were enrolled. Data on age, onset, duration, disease activity, presence of thyroid disorder, other autoimmune diseases, halo nevi, poliosis, and mucosal vitiligo were determined. Serum free triiodothyronine, free thyroxine, total T3, total T4, thyroid‐stimulating hormone, and antibodies to thyroperoxidase and thyroglobulin were measured. Thyroid gland efficiency was evaluated. Results The mean age at onset of vitiligo was 7.26 ± 4.43 years. The duration of vitiligo was 2.26 ± 2.95 years. Vulgaris‐type vitiligo was the most common form in our patients (56%), and 42% reported at least one family member with thyroid disorder, autoimmune disease, or both. Overt hypothyroidism or hyperthyroidism were not detected. We found a significant association between autoimmune thyroiditis and both sex and disease duration (P = 0.046 and P = 0.07, respectively), but no association between autoimmune thyroiditis and age, age at onset of vitiligo, halo nevi, poliosis, mucosal involvement, disease activity, or family history of vitiligo, autoimmunity, or thyroid disorders. Conclusions Children with vitiligo show an increased incidence of autoimmune thyroiditis. Children with vitiligo, especially girls and subjects with generalized/vulgaris‐type vitiligo, should be screened annually for thyroid function and antithyroid antibodies to assist in the early diagnosis and therapy of autoimmune thyroiditis.     

Relevance of thyroiditis and of other autoimmune diseases in children with vitiligo

BACKGROUND: Studies that clearly define the possible association of childhood vitiligo with autoimmune and/or endocrine diseases are lacking. OBJECTIVE: To examine the presence of autoimmune disorders, in particular of thyroid disease, in paediatric patients with vitiligo and investigate the utility of such screening in these patients. METHODS: One hundred and twenty-one paediatric patients (40 males, 81 females) with vitiligo were grouped in segmental and non-segmental vitiligo. All patients were screened for thyroid disease. RESULTS: 13 out of 121 patients had different degrees of thyroid parameter alterations. These patients were all affected by the non-segmental type while none of those with the segmental form presented thyroid alterations. CONCLUSION: In paediatric patients with non-segmental vitiligo, a significant incidence of thyroid dysfunction was found. Since vitiligo usually appears before the development of the thyroid disease, it may be useful to screen thyroid autoantibodies in all paediatric patients with non-segmental vitiligo who present symptoms related to thyroid disease.     

The prevalence of thyroid disease in patients with vitiligo: a systematic review

Background Thyroid disease has been suggested to be associated with vitiligo. However, the outcomes of prevalence studies on thyroid disease in vitiligo vary widely. Objectives To summarize and critically appraise current evidence of the prevalence of thyroid diseases in vitiligo. Methods A systematic review was performed searching the electronic databases OVID MEDLINE, OVID EMBASE and PubMed. Guidelines for the critical appraisal of studies on prevalence of a health problem were adapted to evaluate the methodological quality of the included studies. Results were analysed in a meta‐analysis with a risk ratio (RR). Results Forty‐eight studies published between 1968 and 2012 met the inclusion criteria. Most of the studies (50%) were of fair methodological quality, whereas 18 studies (38%) were of poor quality and six studies (12%) were of good quality. Thyroid disease, autoimmune thyroid disease and presence of thyroid‐specific autoantibodies showed a mean prevalence of, respectively, 15·1%, 14·3% and 20·8% in patients with vitiligo and an RR of, respectively, 1·9, 2·5 and 5·2 (all statistically significant). This review shows an increased prevalence and an increased risk of (autoimmune) thyroid disease in patients with vitiligo compared with nonvitiligo. This risk seems to increase with age. Conclusions Clinicians should be aware of this increased risk in patients with vitiligo and should be attentive for symptoms of thyroid disease. To make recommendations on screening for thyroid disease in patients with vitiligo future research of good methodological quality, including differentiation of vitiligo types and the use of standardized outcome measures, is needed.     

The development of a nomogram model for the individualized prediction of diaper dermatitis risk in pediatric hospitalized children aged 1–36 months

Aims and objectiveTo develop a nomogram model for individualized prediction of diaper dermatitis in pediatric hospitalized infants and toddlers aged 1–36 months.BackgroundDiaper dermatitis is a common skin health problem in pediatrics, which brings pain and discomfort to the child. However, there is a scarcity of risk prediction tools for diaper dermatitis in infants and toddlers hospitalized in pediatrics.DesignA cross-sectional study.Methods210 cases each for caregivers and hospitalized children aged 1–36 months were selected as the research objects. A prediction nomogram model was established based on the risk factors according to the results of univariate analysis and multivariate logistic regression analysis. The predictive performance of the nomogram model was evaluated by discrimination and calibration. The clinical utility of the model was evaluated by decision curve analysis. This study was reported using the TRIPOD checklist.Results41 hospitalized children with diaper dermatitis with a prevalence of 19.52%. The risk factors included: age in months, diarrhea, history of diaper dermatitis, without prophylactic application of buttock protection products, frequency of diaper change per day ≤6.6 times, and the level of caregivers’ knowledge of infantile diaper dermatitis. The results showed that the C-index of the nomogram model was 0.891(95% CI: 0.832, 0.950), the calibration curve manifested a satisfactory consistency, and the net benefit was satisfactory.ConclusionsThe nomogram has a good predictive ability and satisfactory clinical utility, which is useful for pediatric medical staff screening high-risk patients with diaper dermatitis.Relevance to clinical practiceThe prediction nomogram model can help pediatric medical staff to calculate the risk probability of diaper dermatitis in pediatrics, formulate interventions timely, and optimize pediatric DD standardized care protocols.No patient or public contributionthe children's caregivers enrolled in this study only for the data collection.     

Low yield of routine screening for thyroid dysfunction in asymptomatic patients with vitiligo

Background Nonsegmental vitiligo is considered to be an autoimmune disease and is known to be associated with other autoimmune diseases, particularly affecting the thyroid. Screening patients with nonsegmental vitiligo for thyroid function and for the presence of thyroid autoantibodies has been recommended. Objective To investigate the prevalence of thyroid dysfunction and thyroid peroxidase‐specific (TPO) antibodies in a large cohort of patients with nonsegmental vitiligo in order to help decide whether routine screening is justified. Methods A total of 434 adults with nonsegmental vitiligo who were referred to our institute were enrolled. Thyroid function and anti‐TPO antibody titres were assessed in those patients who had no history of thyroid disease or recent thyroid screening. Results Forty‐three patients had already been diagnosed with thyroid dysfunction, and in 27 patients the general practitioner had performed a thyroid function test with negative results < 3 months previously. In these patients, thyroid function assessment was not repeated. The remaining 364 patients were screened for thyroid dysfunction. Overt hypothyroidism was newly diagnosed in three (0·8%) patients; subclinical disease was found in 10 (2·7%) patients and increased levels of TPO antibodies, without thyroid disease, were found in 49 (13·5%) patients. An elevated risk for thyroid disease was found among older women and in women with a positive family history of thyroid disease. Conclusion The overall prevalence of thyroid dysfunction in adult patients with nonsegmental vitiligo was higher than reported in the general population. However, the number of newly diagnosed cases with overt and subclinical thyroid dysfunction in our population was low. Most patients had already been diagnosed by their general practitioner and had symptoms indicative for thyroid disease. Thyroid disease was found predominantly among older women and in subjects with a positive family history of thyroid disease. Thyroid screening including anti‐TPO antibodies is advisable in these high‐risk subpopulations.     

Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricate pathomechanisms

Background Vitiligo/nonsegmental vitiligo (NSV) is often associated with thyroid dysimmunity although very few reports have studied this association using multivariate logistic regression. Objective To identify weighted factors associated with the presence of autoimmune thyroid disease (AITD) in a large cohort of patients with vitiligo/NSV. Methods This was a prospective observational study in 626 patients with a confirmed diagnosis of vitiligo/NSV attending the vitiligo clinic of the University Hospital Department of Dermatology, Bordeaux, France, from 1 January 2006 to 1 May 2012. The Vitiligo European Task Force (VETF) questionnaire was completed for each consecutive patient. AITD was defined as the presence of significant levels of serum antithyroperoxidase antibodies or evidence of autoimmune thyroiditis. Univariate and multivariate logistic regression procedures were conducted to identify factors associated with AITD in this cohort of patients with vitiligo/NSV. Results A total of 626 patients with vitiligo/NSV were included, of whom 131 had AITD (AITD‐vitiligo). Stress as an onset factor, familial history of AITD, body surface involvement and duration of the disease were positively associated with AITD‐vitiligo using univariate analysis, whereas female sex, age at onset of vitiligo, personal history of autoimmune disease and localization on the trunk were found to be independently associated with AITD‐vitiligo. Conclusion Vitiligo associated with AITD has clinical features distinct from vitiligo without AITD. In particular, female patients, and patients with longer duration of disease and greater body surface involvement are more likely to present with AITD and should thus be monitored for thyroid function and antithyroid antibodies on a regular basis.