70例关节病性银屑病患者临床特征研究

目的 探讨关节病性银屑病（PsA）在银屑病中的比例及其临床特征。方法 对2014年1月至2015年1月诊断为银屑病的患者进行横断面研究，通过问卷调查，对疑为PsA患者用PsA分类标准（CASPAR标准）进行确诊，并对确诊为PsA及既往诊断过PsA的患者情况进行登记。两组间统计学分析用t检验，多组间用one?way ANOVA检验，率的比较采用χ2检验，检验均为双侧检验。结果 1 062例银屑病患者中，疑为PsA 125例，确诊PsA 70例（6.59%），其中45例（64.29%）首次确诊，男∶女为2.1∶1。皮损类型以寻常性银屑病占多数，为50例（71.43%）。临床类型如下：非对称性少关节炎性23例，占32.86%、对称性多关节炎性19例，占27.14%、远端指间关节炎性10例，占14.29%、脊椎以及骶髂关节病性7例，占10.00%、残毁型关节炎性11例，占15.71%，各型间有重叠。PsA相对特征性的指趾炎及附着点，分别在14例（20.00%）和8例（11.43%）患者中出现。43例（61.43%）PsA患者出现了指（趾）甲改变。结论 掌握PsA的临床特征，早期诊断，对患者的长期预后具有重要意义。

Clinical features of 70 cases of psoriatic arthritis

Objective To investigate the prevalence of psoriatic arthritis (PsA) in patients with psoriasis and its clinical features.Methods A cross-sectional study was conducted among patients diagnosed with psoriasis from January 2014 to January 2015.Through a questionnaire survey,the diagnosis of PsA was confirmed according to the Classification Criteria for Psoriatic Arthritis (CASPAR) in patients with suspected PsA.Clinical data were collected from patients with newly and previously diagnosed PsA.Statistical analysis was carried out by t test for two-group comparisons,one-way analysis of variance (ANOVA) for multi-group comparisons,and chi-square test for comparisons of rates.All the statistical tests were two-sided.Results Totally,1 062 outpatients with psoriasis were enrolled into this study,and 125 were suspected to have PsA.According to the CASPAR,70 (6.59％) patients were finally diagnosed with PsA,with the ratio of male to female being 2.1 ∶ 1,and 45 of them (64.29％) were newly diagnosed.Psoriasis vulgaris lesions were observed in 50 (71.43％) patients with PsA,and were the most common type of skin lesions in patients with PsA.There were 5 clinical types of PsA in these patients,including asymmetrical oligoarthritis (23 cases,32.86％),symmetric polyarthritis (19 cases,27.14％),distal interphalangeal predominant arthritis (10 cases,14.29％),vertebral or sacroiliac arthropathy (7 cases,10.00％),and arthritis mutilans (11 cases,15.71％),with some overlap among these clinical types.As relatively distinctive manifestations of PsA,dactylitis and enthesitis were observed in 14 (20.00％) and 8 cases (11.43％) respectively.In addition,43 (61.43％) cases had nail involvements.Conclusion To master clinical features of PsA and to diagnose it early are of great significance for long-term prognosis of PsA patients.