银屑病患者配偶生活质量现状及影响因素分析研究

目的 探讨银屑病患者配偶的生活质量现状,并对其影响因素进行分析。方法 采用便利抽样法,选取2022年7月—2023年1月在同济大学附属上海市皮肤病医院就诊的245对斑块状银屑病患者及其配偶为研究对象。采用一般资料调查表、家庭皮肤病生活质量指数（FDLQI）、皮肤病生活质量指数（DLQI）、医院焦虑和抑郁量表（HADS）进行调查。配偶的生活质量影响因素的分析采用Kruskal-Wallis检验、Mann-Whitney U检验、相关分析及多元线性回归分析。结果 银屑病患者配偶生活质量评分为（7.65±6.47）分,其中,89.6%的配偶报告生活质量有受损情况。单因素分析结果显示,患者的教育程度、是否累及指甲、既往是否接受传统治疗、体表受累面积（BSA）、躯干银屑病面积和严重程度指数（PASI）、上肢PASI、下肢PASI、临床医师整体评估（PGA）、DLQI、患者对病情的总体评估（PtGA）、焦虑和抑郁评分以及配偶自身焦虑和抑郁评分,均与配偶的FDLQI显著相关（P<0.05）。多元线性回归分析结果显示：患者的BSA、DLQI、PtGA和配偶自身的焦虑评分是影响配偶生活质量的因素。...     

寻常痤疮患者抑郁、焦虑及生活质量分析

目的:对寻常痤疮患者进行抑郁、焦虑、生活质量等的心理评估,为寻常痤疮综合治疗提供参考.方法:使用整体痤疮评分系统(Global Acne Grading System,GAGS)评价患者皮损严重程度,采用BECK 抑郁量表、状态- 特质焦虑量表、皮肤生活质量量表评价患者心理状态.结果:230 例患者参与本次研究.Logistic 回归显示:病程短者生活质量越易受影响;年龄长者越易抑郁评分高;女性患者越易焦虑- T 评分高.方差分析显示:女性焦虑- T 评分较高.青年组生活质量评分较高.中度、重度组生活质量评分较高.结论:寻常痤疮患者生活质量受影响程度更大,女性、19 ～ 24 岁、中重度痤疮患者更易出现抑郁、焦虑、生活质量评分偏高.性别、年龄、病情、病程是抑郁、焦虑、生活质量评分异常的影响因素.对于易感人群应给予相应心理干预以提高疗效.     

他汀类药物与患者抑郁、焦虑情绪的关系研究

目的探讨他汀类药物对患者抑郁、焦虑情绪产生的影响。方法应用抑郁自评量表（SDS）和焦虑自评量表（SAS）对患者抑郁、焦虑情绪状态进行评分,采用t检验初步比较应用他汀类药物治疗组和未服药组之间量表评分的差异;然后对2组的有关因素采用t检验或χ^2检验进行比较;最后,采用多元线性回归进行影响因素的分析。结果服药组与未服药组比较,抑郁和焦虑量表评分均无差异。结论他汀类药物对患者抑郁和焦虑情绪无影响。     

慢性盆腔炎患者生活质量影响因素调查研究

目的：探讨慢性盆腔炎患者生活质量影响因素,旨在为针对性采用干预措施提高患者的生活质量提供参考依据。方法：采用自编问卷、抑郁自评量表（SDS）、焦虑自评量表（SAS）、社会支持评定量表（SSRS）、匹兹堡睡眠质量指数问卷（PSQI）和汉化版简明健康调查表（SF-36）。量表调查2011年6月～2012年12月在我中心妇科治疗的50例慢性盆腔炎患者和同期50例在我中心健康体检女性的生活质量和影响因素,采用SPSS16．0软件进行分析找出慢性盆腔炎患者生活质量现状和影响因素,为针对性采用干预措施提高患者的生活质量提供参考依据。结果：慢性盆腔炎患者的生活质量明显低于健康体检女性,差异有统计学意义（P〈0．05）。多元线性逐步回归分析示受教育程度高、患者对慢性盆腔炎了解多和社会支持评定量表总分高与慢性盆腔炎患者生活质量正相关,而焦虑抑郁标准分高和有睡眠问题与慢性盆腔炎患者生活质量负相关。结论：慢性盆腔炎患者生活质量较正常女性低,生活质量的高低受多方面因素的影响,为此,加强对慢性盆腔炎患者健康宣教,给予更多的社会支持和鼓励,改善患者的睡眠质量,提高患者的生活质量。     

慢性湿疹患者述情障碍和焦虑评估及生活质量相关影响因素分析

目的 探讨慢性湿疹(chronic eczema, CE)患者述情障碍、焦虑的程度与生活质量的相关性。方法 随机抽取马鞍山市人民医院皮肤科的200例慢性湿疹患者及202例健康人群作为对照组进行分析，运用湿疹面积和严重指数(eczema area and severity index, EASI)、睡眠和瘙痒数字评分量表(visual analog scale for sleep and itch, VAS)、多伦多述情障碍自评量表(Toronto alexithymia scale, TAS)-26、焦虑自评量表(self-rating anxiety scale, SAS)、皮肤病生活质量指数(dermatology life quality index, DLQI)进行症状量化评分。利用独立样本t检验和卡方检验，对两组人群的述情障碍、焦虑、生活质量量表得分进行分析比较，利用多元有序Logistic回归分析慢性湿疹患者生活质量相关的因素。结果 慢性湿疹组TAS-26得分为66.90±11.37,显著高于对照组得分(59.02±10.07)(P<0.01)。慢性湿疹组SAS平均分...     

特应性皮炎患者生活质量及心理特征调查分析

目的调查特应性皮炎(AD)患者生活质量、焦虑、抑郁情况及其影响因素,为提高AD患者生活质量提供相应理论支持。方法采用手机扫描二维码登陆腾讯问卷平台,填写皮肤病生活质量指数(DLQI)和焦虑(SAS)、抑郁(SDS)程度自评表,对527例AD患者进行问卷调查,评估其生活质量与焦虑抑郁心理特征,使用方差分析和logistic回归分析其影响因素。结果问卷调查结果通过logistic分析,生活质量主要影响因素包括年龄、学历、职业;中-高度焦虑症主要影响因素为民族、婚姻;中-高度抑郁症主要影响因素是婚姻状况、学历。皮肤病生活质量影响程度,焦虑程度和抑郁程度三者进行Sperman秩相关分析显示,三者两两正相关。结论AD影响患者生活质量,并且给患者心理带来严重的负面影响。     

雄激素性脱发和斑秃患者生活质量及抑郁情况调查分析

目的 调查脱发患者生活质量与抑郁状态及其影响因素,为改善其生活质量采取相应临床对策提供依据.方法 采用皮肤病生活质量指数(DLQI)和流行病学研究中心抑郁量表(CES-D),对雄激素性脱发和斑秃脱发患者237例进行问卷调查,评估其生活质量与抑郁状况,使用方差分析和logistic回归分析其影响因素.结果 237例脱发患者收集到有效答卷218份,218例脱发患者DLQI量表均分为9.1±5.4,总体上脱发对生活质量的影响为中度影响,重度及以上影响者占38.07%.CES-D量表均分为14.8±9.9,有抑郁倾向者占37.61%.DLQI得分和CES-D得分呈正相关(r=0.29,P<0.01).单因素方差分析结果显示,不同年龄、性别、文化程度及就诊次数对DLQI得分差异无统计学意义.多因素logistic回归分析显示,脱发患者发生抑郁倾向的危险因素有:就诊次数(OR=1.81,95%CI:1.21~2.69)和DLQI影响程度(OR=1.08,95%CI:1.03~1.13).结论 脱发不仅影响患者生活质量,而且给患者心理带来负面影响.     

维持性血液透析女性肾病患者性功能障碍的调查分析

目的:探讨调查分析维持性血液透析女性肾病患者性功能障碍情况。方法:选自我院于2014年9月至2016年9月收治的维持性血液透析肾病患者71例,选择同期于我院健康体检者50例。应用性功能女性性功能指数(FSFI)评估量表对性功能进行评价,采用SF-36生活调查量表对生活质量进行评价。比较两组性功能障碍发生情况、性功能指数评分及SF-36S生活量表评分变化。结果:观察组发生性功能障碍患者27例、发生率为38.03%;观察组阴道润滑程度、性生活满意度、性唤起、性高潮、性欲、性交疼痛评分低于对照组,且均有统计学差异(P0.05);观察组PF、BP、VT、RE、MH、RP、GH及SF评分低于对照组,且均有统计学差异(P0.05)。结论:维持性血液透析女性肾病患者性功能障碍发病率高,且生活质量和性功能状况均差于正常人群。     

男性抑郁症患者性功能障碍的影响因素研究

目的 调查中国男性抑郁症患者性功能障碍的发生情况及影响因素。方法 选取2016年5月至2017年10月收集的99例门诊抑郁症患者作为研究对象,进行横断面、观察性研究。收集患者的基线资料、抑郁病史和用药信息,患者自评完成亚利桑那性体验量表(ASEX)、抑郁症状快速评估量表(QIDS-SR₁₆)、广泛性焦虑自评量表(GAD-7)和患者健康问卷(PHQ-15)。根据ASEX评估标准将患者分为性功能障碍与无性功能障碍,采用Logistic回归分析男性抑郁症患者发生性功能障碍的相关因素。结果 共38例(38.4%)患者发生性功能障碍。性功能障碍患者与无性功能障碍患者受教育程度、年龄、平均月收入、QIDS-SR₁₆总分、PHQ-15总分比较,差异具有统计学意义(P<0.05)。年龄(31～40岁)、平均月收入(>5 000元)是性功能障碍的保护因素,躯体症状严重程度是性功能障碍的危险因素。结论 男性抑郁症患者发生性功能障碍与其年龄、收入及躯体症状相关。     

不孕女性心理状态影响因素的Logistic回归分析及心理状态与生存质量的关系

目的 探讨不孕女性的心理状态现况、影响因素及其与生存质量的关系。方法 回顾性分析2019年1月至2022年1月江苏省人民医院收治的398例不孕女性的临床资料。统计不孕女性心理状态现况,分析不孕女性焦虑、抑郁症状的影响因素,采用Pearson法分析生存质量与心理状态的相关性,采用多因素Logistic回归分析法分析不孕女性焦虑、抑郁症状的危险因素,并构建Logistic回归方程。结果 398例不孕女性中焦虑患者占16.08%,抑郁患者占22.11%。焦虑组、抑郁组年龄≥40岁、初中及以下学历、未获得家庭支持、原发不孕的患者占比分别高于无焦虑组和无抑郁组(P<0.05)。焦虑症状、抑郁症状均与生存质量呈反比(r=-0.476、-0.731,P<0.05)。多因素Logistic回归分析结果显示,年龄≥40岁、初中及以下、未获得家庭支持、原发不孕是不孕女性焦虑、抑郁症状的独立危险因素(P<0.05)。分别建立不孕女性焦虑、抑郁症状回归方程模型：logit(P)=-12.321+年龄×0.932+教育水平×1.023+是否获得家庭支持×0.976+不孕类型×0.897;log...     

ANDROGENS IN THE TOPICAL TREATMENT OF LICHEN SCLEROSUS

Background. Testosterone propionate has been shown repeatedly to be effective in the treatment of vulvar lichen sclerosus, yet studies of androgens in serum of women with untreated vulvar lichen sclerosus suggested an abnormal activity of 5-alpha reductase in these patients. If impairment of 5-alpha reductase in women with untreated vulvar lichen sclerosus is a proximate cause of this disease, then dihydrotestosterone should be more effective than testosterone propionate in the treatment of the condition. Methods. To test this hypothesis, five women with vulvar lichen sclerosus received topically either dihydrotestosterone or testosterone propionate in a double-blind crossover study. Results. These androgens appear to be equally effective in inducing objective improvement of the vulvar lichen sclerosus by both gross and microscopic criteria. Conclusions. Impairment of 5-alpha reductase may not be germane to the pathogenesis of vulvar lichen sclerosus.     

The period prevalence of oral lichen planus in a cohort of patients with vulvar lichen sclerosus

Background Lichen sclerosus and lichen planus are chronic inflammatory mucocutaneous disorders that may coexist. Objective The aim of this study was to estimate the period prevalence of oral lichen planus in a cohort of patients with vulvar lichen sclerosus and to document their clinical characteristics. Methods We report a series of cases of vulvar lichen sclerosus presenting to two dermatologist‐led vulvar clinics in Oxfordshire, England between 1997 and 2007 with coexistent clinical signs of oral lichen planus. Results Thirteen cases with coexistent vulvar lichen sclerosus and oral lichen planus were identified, of which five had oral biopsies. Four oral biopsies showed histological features consistent with lichen planus. One oral biopsy was not diagnostic but compatible with oral lichen planus. No cases of oral lichen sclerosus were identified. The period prevalence of oral lichen planus was 6 per 1000 cases of vulvar lichen sclerosus. Conclusion The period prevalence of oral lichen planus in women with vulvar lichen sclerosus (0.6%) is similar to that reported for oral lichen planus in the general population (1–2%).     

Histology of lichen sclerosus varies according to site and proximity to carcinoma.

To investigate why vulvar but not extragenital lichen sclerosus is associated with squamous cell carcinoma, we performed a histologic study of extragenital lichen sclerosus, vulvar lichen sclerosus without carcinoma, and vulvar lichen sclerosus with carcinoma adjacent to and distant from the carcinoma. We compared epidermal thickness, rete ridge length, mitotic activity, atypia, dermal collagen change, dermal inflammation, and presence of other dermatoses in 30 women in each group. Extragenital lichen sclerosus showed thinner epidermis (mean thickness of 0.13 mm versus 0.41 mm; P < 0.0005), shorter rete ridges (P = 0.0001), more dermal edema (P = 0.16), and absence of associated dermatoses of spongiotic dermatitis and lichen planus (P < 0.005) compared with vulvar lichen sclerosus. The epidermal thickening seen in vulvar lichen sclerosus was indistinguishable from lichen simplex chronicus. Vulvar lichen sclerosus without carcinoma was generally similar to that distant from carcinoma. Vulvar lichen sclerosus adjacent to carcinoma showed increased epidermal thickness (0.61 mm versus 0.26 mm; P < 0.005), more dermal fibrosis (P < 0.0005), more inflammation (P < 0.0005), and more simplex (differentiated) vulvar intraepithelial neoplasia (18 cases versus 1 case; P < 0.0005) compared with that distant from carcinoma. We concluded that (1) the classic histologic features of lichen sclerosus are seen in both vulvar and extragenital sites; (2) vulvar lichen sclerosus without associated carcinoma has a mean epidermal thickness more than three times that of extragenital lichen sclerosus; (3) the epidermal thickening is histologically indistinguishable from lichen simplex chronicus; (4) there is a tendency for vulvar lichen sclerosus to have a more sclerotic and inflamed dermis; (5) lichen sclerosus 10 mm from cancer is more similar to vulvar lichen sclerosus without carcinoma than lichen sclerosus 1 mm from carcinoma; and (6) lichen sclerosus adjacent to carcinoma tends to show exaggerated epidermis thickness, basal atypia, and loss of the edematous-hyaline layer.     

Childhood Onset Vulvar Lichen Sclerosus Does Not Resolve at Puberty: A Prospective Case Series

Abstract: When vulvar lichen sclerosus occurs in prepubertal children it is widely believed that it is likely to remit at puberty. However when it occurs in adult women it is accepted that remission is unlikely and that in addition untreated or inadequately treated disease may be complicated by significant disturbance of vulvar architecture and less commonly squamous cell carcinoma. Our database reveals 18 girls who developed lichen sclerosus prior to puberty who are now adolescents or young adults. Twelve have remained under surveillance and the other six patients have been lost to follow‐up. We report a prospective series of these 12 patients. Three patients have achieved complete remission sustained for three or more years, all prior to menarche. Nine patients, or 75% of the cohort, who still had active lichen sclerosus at puberty continue to require maintenance therapy after menarche. Of the 12, six have had significant disturbance of vulvar architecture. The concept that prepubertal lichen sclerosus resolves at puberty would appear not to be true in the majority of patients. Even when diagnosed early and treated effectively, childhood onset lichen sclerosus may be complicated by distortion of vulvar architecture.     

Vulvar squamous cell carcinoma and lichen sclerosus

There are two clinicopathological types of vulvar squamous cell carcinoma, human papillomavirus (HPV)-positive and HPV-negative, which can be distinguished to some degree on routine histology. Human papillomavirus-positive carcinomas account for one-quarter to one-third of cases, occur in women on average 20 years younger than in HPV-negative, and are associated with multiple lower genital tract neoplasia. Human papillomavirus negative carcinoma is linked to lichen sclerosus. Of all carcinomas, 7-96% show lichen sclerosus in skin adjacent to the carcinoma, the majority being the first presentation of lichen sclerosus, and up to 5% of patients with lichen sclerosus develop carcinoma after long-term follow up. Where lichen sclerosus is associated with malignancy, it is often hyperplastic, may show a subtle form of intraepithelial neoplasia termed 'differentiated vulvar intraepithelial neoplasia', and may lose its pathognomonic oedematous-hyaline layer. The local additional factors causing lichen sclerosus to develop malignancy on the vulva are not known.     

Vulvar Lichen Sclerosus

Lichen sclerosus is a chronic disorder of the skin and mucosal surfaces, and is most commonly seen on the female genital skin. It also occurs on other areas of the body. Any age group may be affected, although it is seen more often in elderly women. The exact cause of lichen sclerosus is unknown. There have been reports of family members with lichen sclerosus; thus it may have a genetic link. There is also the possibility of an autoimmune connection. Currently, ultra-potent topical corticosteroids are the medical treatment of choice. Other treatments that have been utilized for this condition include testosterone, progesterone, tacrolimus, surgery, and phototherapy. Surgery should be reserved for symptomatic patients who fail to respond to multiple medical treatments, as there is a high recurrence rate following surgery. The risk of developing squamous cell carcinoma of the vulva approaches 5% in women with vulvar lichen sclerosus, and therefore close surveillance by the healthcare provider and patient is needed. This review discusses the history, clinical features, pathophysiology, and treatment of lichen sclerosus of the vulva, as well as pregnancy issues and sexual function in patients with this condition. In addition, problems specific to children with lichen sclerosus are reviewed.     

Overexpression of wild-type p53 in lichen sclerosus adjacent to human papillomavirus-negative vulvar cancer

Human papillomavirus is a risk factor for vulvar cancer, whereas human papillomavirus-negative late onset vulvar carcinoma is associated with the dermatologic condition, lichen sclerosus. Human papillomavirus E6 protein targets TP53 for degradation and by inference it has been assumed that human papillomavirus-negative vulvar cancer is dependent upon the acquisition of p53 somatic mutations and subsequent allelic loss. To investigate this, TP53 expression, loss of heterozygosity, and p53 genomic sequence were examined in 29 cases of human papillomavirus-negative vulvar carcinoma with adjacent lichen sclerosus. We examined 37 cases of lichen sclerosus without vulvar carcinoma, 10 cases of nongenital lichen sclerosus, and 12 cases of normal vulvar epithelium served as controls. TP53 was evident in 72% of vulvar carcinoma, 48% in epithelium adjacent to vulvar carcinoma, but was minimal in normal samples. When lichen sclerosus cases were selected to exclude samples with absolutely no TP53 expression through probable failed antigen retrieval or homozygous p53 loss the number of epithelial cells expressing TP53 increased progressively from nongenital lichen sclerosus to lichen sclerosus without vulvar carcinoma, then to lichen sclerosus with vulvar carcinoma (p<0.0001). These data suggest elevated TP53 is a feature of vulvar lichen sclerosus. Seventy-four percent of vulvar carcinoma had chromosome 17p-linked loss of heterozygosity, whereas 47% of adjacent lichen sclerosus featured loss of heterozygosity, but only 31% of vulvar carcinoma had p53 mutations, a frequency less than reported previously. Seven percent of adjacent lichen sclerosus had mutations, showing for the first time the presence of an identical mutation to the matched vulvar carcinoma. These data, however, implicate p53 mutations as a later event in vulvar carcinoma and in marked contrast to the original expectation, our loss of heterozygosity data are consistent with loss of another locus (not p53) on 17p operating as a tumor suppressor in lichen sclerosus destined to develop vulvar carcinoma.     

Vulvar Dermatoses: Diagnosis,Management, and Impact on Sexual Function

Physicians often feel challenged in the diagnosis and management of vulvar diseases and their effects on psychosexual health. Vulvar dermatoses must be considered in the differential diagnosis of women experiencing female sexual dysfunction or vulvovaginal pain. This review will focus on the diagnosis and treatment of common vulvar dermatoses, including vulvar contact dermatitis, lichen simplex chronicus, vulvar psoriasis, lichen sclerosus, lichen planus, and vulvar intraepithelial neoplasia. The impact of these disorders on sexual well-being will be emphasized. A detailed history and physical examination, backed by confident knowledge of vulvar dermatoses, will aid in diagnosis and management of these diseases. Current gold-standard treatments will be discussed as well as innovative therapeutic approaches currently being developed. With increased clinician awareness and further research, vulvar dermatoses and resulting sexual dysfunction can be appropriately managed.     

前列腺增生手术患者术后性生活质量及其影响因素研究

目的:研究前列腺增生手术患者术后性生活质量及其影响因素,以为患者术后性生活质量的改善提供依据。方法:选取2015年2月至2016年4月期间于本院进行手术治疗的108例前列腺增生患者为研究对象,将其采用SLQQ-QOL量表进行评估,然后分别比较不同年龄、文化程度、社会支持程度、情绪状态、自我效能感、疾病认知度、前列腺分度、手术并发症情况及手术方式患者的评估结果,并采用Logistic回归分析处理上述因素与此类患者术后性生活质量的关系。结果:108例患者的SLQQ-QOL量表评估结果较差,其中年龄较高、文化程度较低、社会支持程度较低、抑郁焦虑、自我效能感较低、疾病认知度较低、前列腺分度较高、存在手术并发症及TURP治疗者的SLQQ-QOL量表评估结果差于年龄较低、文化程度较高、社会支持程度较高、无焦虑抑郁、自我效能感较高、疾病认知度较高、前列腺分度较低、无手术病灶及TUBVP治疗者,且Logistic回归分析显示,上述因素均与此类患者的术后性生活质量有密切的关系,P均<0.05。结论:前列腺增生手术患者术后性生活质量较差,且多类因素对其影响较大,应针对这些因素给予充分干预。