皮肤病综合征

20032291 58例白塞病回顾性分析/陈岚(华中科技大同济医院皮肤科)…//中国麻风皮肤病杂志.-2003,19(1).-25～27 本组以女性、慢性型多见,好发于青壮年。急性21例,发病诱因以上呼吸道感染为主(15例占71,43％),尤其应注意病毒或细菌感染。临床表现以口腔、皮肤、生殖器、眼和关节受累常见。针刺反应阳性31/58例,占53.45％,为本病诊断的重要体征;皮肤外伤后创面延迟愈合(23例,占39.66％)对本病诊断也有重要价值。参9(张秉     

17例白塞病临床回顾分析

目的总结和分析白塞病的临床及治疗特点，以加强对白塞病的认识，提高临床诊治水平．方法回顾性分析17例白塞病患者初发部位、临床表现、实验室和病理检查及治疗的情况。结果本组白塞病以男性多见，好发于（20～50）岁，大部分患者以口腔溃疡为首发表现（70.59％），口腔溃疡的发生率为100％，生殖器溃疡为58．82％，眼部损害为29．41％，针刺反应阳性率为47.06％，皮肤损害以结节性红斑最多见（52．94％），关节受累41．18％，除此外，白塞病尚可累及消化道和神经系统。实验室检查无特异性，病理检查符合血管炎改变，应用激素、免疫抑制剂或联合治疗，所有病例病情均缓解。结论白塞病的诊断主要依靠临床症状．反复口腔溃疡是诊断白塞痛的主要依据．针刺反应有辅助诊断意义．白塞痛治疗目前尚无统一方法，糖皮质激素、免疫抑制剂等治疗能很好地控制病情。     

白塞病患者血清抗中性粒细胞胞浆抗体及抗血管内皮细胞抗体检测

为探讨血清抗中性粒细胞胞浆抗体（ANCA）及抗血管内皮细胞抗体（AECA）在白塞病发病中的作用和意义。收集白塞病患者和正常人血清，用间接免疫荧光技术检测血清中ANCA和AECA，并分型。结果：32例白塞病患者ANCA阳性率为12．5％，均为核周型ANCA（P—ANCA），与正常对照组比较差异无显著性（P〉0．05）。AECA阳性率为81．3％，其中IgC—ANCA阳性率为71．9％，IgM—AECA阳性率53．1％，与正常对照组比较有显著性差异（均P〈0．01）。在发生结节性红斑或结节性血管炎及血沉增快方面AECA阳性组高于阴性组（P〈0．01）；而在口腔溃疡、外生殖器溃疡和贫血等临床表现方面ANCA及AECA阳性组与阴性组比较差异均无显著性（P〉0．05）。白塞病患者血清AECA测定对白塞病患者血管损害及病情活动具有一定意义。     

皮肤综合征

20 0 4 1787　 5 8例白塞病回顾性分析 /陈岚 (华中科大同济医学院同济医院皮肤科 )… //中国麻风皮肤病杂志 .- 2 0 0 3,19(1) .- 2 5～ 2 7分析结果显示 ,该组病人以女性、慢性型多见 ,好发于青壮年。 2 1例急性型发病诱因以上呼吸道感染为主 ,占 71.4 3% ,应注意病毒或细菌感染在急性型发病机制中的作用。临床表现以口腔、皮肤、生殖器、眼和关节受累常见。31例针刺反应阳性 ,占 5 3.4 5 %。提示针刺反应对本病特异性高。皮肤外伤后创面延迟愈合 (2 3例 ,占 39.6 6 % )对诊断有重要价值。参 9　 (张秉正 )2 0 0 4 1788　生脉注射液治疗原…     

儿童银屑病40例临床分析（摘要）

儿童银屑病４０例临床分析（摘要）马玉宏，刘向萍（武警陕西省总队医院７１００５４）通过对４０例儿童银屑病的临床分析，发现儿童银屑病大多有发病诱因，占７２．５％，其中感染占４２．５％；发病特点为急性发病，皮损为泛发点滴型，多累及前额，皮疹以渗出为主；治疗...     

皮肌炎86例分析

为了探讨皮肌炎的临床表现、治疗反应与恶性肿瘤的关系，回顾性分析了８６例皮肌炎的临床资料。８６例中，男２１例，女６５例，男女之比为１：３．１。发病年龄７５％在２０￣６０岁之间。初发症状以皮炎（５１．２％）和皮炎肌炎同时发生（４４．２％）多见。皮肤损害以上眼睑紫红色浮肿性红斑（８４．９％）、Ｇｏｔｔｒｏｎ丘疹（５９．３％）、皮肤异色症（６１．６％）及甲周红斑（４１．９％）多见。肌肉受累以上肢近端（８０     

白塞病78例临床分析

目的了解白塞病的临床特点。方法回顾性分析78例白塞病患者的诱因、起病类型、初发部位、临床表现、实验室和病理检查情况及其治疗方法。结果白塞病多见于女性,男:女=1:1.44,好发于青壮年(20~45岁),多为慢性起病,27例急性型发病诱因以上呼吸道感染为主(19例,占70.37%),最常见症状依次是口腔溃疡(96.15%)、皮肤损害(78.21%)、生殖器溃疡(42.31%)、眼部损害(37.18%),其余症状相对较少;实验室检查和病理检查无特异性,皮肤针刺反应阳性率52.56%。结论白塞病的诊断主要依靠临床症状,针刺反应有辅助诊断意义。     

皮肤鳞状细胞癌临床和病理分析

目的探讨皮肤鳞状细胞癌的临床和病理特点。方法收集2009--2012年经组织病理诊断为皮肤鳞状细胞癌的58例患者的临床及病理资料,对临床和组织病理学特征进行回顾分析。结果皮肤鳞状细胞癌高峰发病年龄为70～89岁,皮损见于头面部27例（46．55％）,外生殖器部位20例（34．48％）,四肢9例（15．52％）,躯干2例（3．45％）。临床上表现为结节隆起型27例,占46．55％,深在浸润型19例,占32．76％,溃疡型12例,占20．69％。组织病理表现为经典型51例,特殊类型7例（疣状型5例、腺性鳞癌1例、透明细胞型1例）。结论皮肤鳞状细胞癌好发于老年人曝光部位,应及早进行组织病理学检查以明确诊断,提高患者生存率。     

葡萄球菌性烫伤样皮肤综合征35例临床分析

目的：分析葡萄球菌性烫伤样皮肤综合征（staphylococcal scalded skin syndrome，SSSS）的发病年龄、诱发因素、临床表现、实验室检查、治疗及预后。方法：回顾性分析35例儿童金葡菌烫伤样皮肤综合征的临床资料。结果：35例病例中，有21例发生于3岁以内婴幼儿，约占总病例的60％；发病中位年龄为2岁5个月；皮损主要表现为触痛性红斑、松弛性大疱、表皮剥脱（100％），口周放射状皲裂（94．3％），发热（42．9％），结膜炎（37．1％），实验室检查血白细胞及c反应蛋白未见显著性升高。结论：SSSS近年来时有发生，婴幼儿触痛性红斑、松弛性大疱、表皮剥脱伴口周放射状裂纹时应高度怀疑本病。早期、足量、有效的使用抗生素，是治疗的关键，联合大剂量静脉注射免疫球蛋白，可明显缩短病程。     

1333例皮肤恶性肿瘤回顾性分析

目的了解重庆地区皮肤恶性肿瘤的发病情况及特点。方法收集和回顾性分析第三军医大学西南医院皮肤科1991年～2010年经组织病理确诊的皮肤恶性肿瘤患者临床资料。结果共统计1333例皮肤恶性肿瘤患者,男女之比为1．26：1,其中基底细胞癌454例（占34．06％）、鳞状细胞癌235例（占17．63％）、鲍恩病136例（占10．20％）、恶性黑素瘤133例（占9．98％）、乳房及乳房外Paget病104例（占7．80％）。临床诊断与组织病理诊断符合率为72．4％,符合率最高的是乳房及乳房外Paget病（93．27％）。基底细胞癌主要发生于头面部和颈部,鲍恩病多见于躯干部位,恶性黑素瘤的主要发病部位在足跖。结论相对于国内外其他研究资料,重庆地区的皮肤恶性肿瘤发病情况具有一定的自身特点。     

生殖器疱疹合并感染的临床研究

目的:分析并探讨生殖器疱疹合并感染的临床特点,从而为临床诊断提供依据。方法:选取2010年1月至2016年1月期间在我院就诊的性病门诊患者574例。采用回顾性分析的方法,总结患者临床资料,分析临床特征。结果:574例患者中,生殖器疱疹372例,占64.81%,硬下疳占17.42%,淋菌性包皮龟头炎占1.74%,念珠菌性包皮龟头炎占3.66%,白塞病占1.22%,其他类型占11.15%。372例生殖器疱疹患者平均年龄为(36.35±6.34)岁,男性患者占78.23%,女性占21.77%。初次发病占30.11%,复发占69.89%。合并其他感染87例,占23.39%,其中以合并尖锐湿疣为主,占8.60%。HSV-1感染者24例(6.54%),HSV-2感染者348例(23.39%)。所有合并感染者均为HSV-2感染者。结论:生殖器疱疹是临床常见性病之一,容易合并其他性传播疾病,HSV-2型为易感其他疾病类型,临床上要早期诊断。     

Chromosome and sister chromatid exchange studies in Behcet's patients

Behcet's disease is a chronic multisystemic disease of unknown pathogenesis characterized by four major symptoms: oral aphthous ulcers, skin lesions, ocular symptoms and genital ulcerations. The disease is spread throughout the world, but it is most frequent in Turkey, Japan, Korea and China. Although HLA-Bw51 has been found to predominate in Behcet's cases, the genetic etiology has not yet been clarified. In this study, we investigated the chromosomal abnormalities and sister chromatid exchange rates in patients with Behcet's diseases. Thirty-eight patients with Behcet's disease (diagnosed for the first time) and 30 healthy subjects (as controls) were included in this study. Although numerical and structural chromosomal abnormalities were not detected in our patients, we found an increased rate of sister chromatid exchange in patients over the control groups (P < 0.01). On the basis of these results, we discuss the genetic etiology of Behcet's disease.     

白塞病64例临床分析

目的：探讨白塞病的临床特点及实验室改变。方法：对64例BD患的临床及实验室资料进行统计分析。结果：口腔溃疡61例,外生殖器溃疡44例,眼部损害21例,皮肤损害33例,针刺反应阳性39例。首发症状以口腔溃疡最常见（42例）。6例并发心血管系统损害,5例并神经系统损害,1例并急性肾功能衰竭,1例并食道下段溃疡并出血;实验室检查有多项免疫学指标的异常,12例检测到自身抗体（12／40）;皮肤及粘膜组织活检病理改变均符合小血管炎症。结论：白塞病是累及全身多系统器官以血管炎改变为基础的免疫性疾病,皮质类固醇激素或激素并免疫抑制剂治疗有较好的临床疗效。     

白塞病42例临床分析

目的：探讨白塞病（BD）的临床特点。方法：回顺性分析42例BD患者的临床及实验室资料。结果：BD好发于青壮年，多慢性起病，可累及多个器官系统，各受累部位的频率依次为：口腔42例（100％），生殖器29例（69．0％），皮肤28例（66．7％），关节18例（42．9％），眼18例（42．9％），神经系统6例（14．3％），消化道4例（9．5％），大血管3例（7．1％），呼吸系统2例（4．8％），肾脏1例（2．4％），心脏1例（2．4％）。针刺反应阳性32例（76．2％）。皮肤组织活检12例，病理改变均符合皮肤血管炎。随访发现5例死亡个案中2例为BD肠病，1例为BD肺病，1例为BD脑病。结论：BD是一种以血管炎为基础的可累积全身多器官系统的免疫性疾病，重要脏器受累预后不良。皮质类固醇激素或联合应用免疫抑制剂有较好的临床疗效，但亦带来一定的副作用。     

Behcet病21例临床分析及眼内超声表现

目的：探讨Behcet病的临床特征以及超声检查对眼部损害的诊断价值。方法：回顾性分析了21例Behcet病的临床资料，包括8例眼部损害患者（13只眼）的超声图像特点。结果：口腔溃疡、外生殖器溃疡、皮肤损害、眼部病变是本组Behcet病的基本临床特征，以口腔溃疡最常见。前房积脓，玻璃体雪球状浑浊，伴粟粒样强回声光点及纤维光带形成等是Behcet病的主要超声表现。结论：某些口腔溃疡反复发作常规治疗效果欠佳时，可能是Behcet病的早期表现。超声检查可对Behcet病眼部损害以及本病的早期诊断提供有用的影像学依据。     

白塞病的血管损害与免疫学改变

目的：探讨白塞病（ＢＤ）的血管损害以及免疫学改变。方法：对４５例ＢＤ患者的临床及病理学资料进行分析。结果：１４例皮肤组织活检、１例扁桃体活检及１例食道粘膜活检病理改变均符合小血管炎症。２例（２／１２）皮肤直接免疫荧光（ＤＩＦ）阳性，为真皮小血管壁ＩｇＭ和Ｃ３ｃ沉积。４例并发心血管系统损害，其中２例为冠状动脉瘤伴血栓形成。１例为脑栓塞性舞蹈病，１例为食道下段溃疡并出血。有多项免疫学指标异常。１０例检     

间接免疫荧光检查对白塞病的临床意义

根据白塞病(BD)国际分类标准,确诊为本病的35例作为研究组,取其口腔、生殖器、皮肤和血管病损组织进行荧光检测。选用复发性阿夫他口炎(RAS)20例作为对照组。结果显示:BD88.6%患者血清中可检测出口腔粘膜的自身抗体,85.7%患者血清中可检测出病损皮肤、血管组织的自身抗体,75%患者血清中可检测出生殖器溃疡部位的自身抗体,前者与RAS比较,P<0.01。由于检测方法不同,本文用间接荧光法阳性结果较高。故用本法检测无疑对BD诊断有一定临床价值。     

Serum interleukin 18 and tumour necrosis factor-alpha levels are increased in Behcet's disease

Inflammation in Behcet's disease is thought to be mediated by cytokines derived from T-helper type 1 (Th1) lymphocytes. In this study, we tried to determine serum interleukin (IL)-18 and tumour necrosis factor (TNF)-alpha levels of patients with Behcet's disease. Twenty-seven patients with active Behcet's disease, and 20 healthy control subjects were included in this study. Differences between mean serum IL-18 and TNF-alpha level of patients with Behcet's disease were significantly increased when compared with the control group. A significant correlation was found between serum IL-18 and TNF-alpha levels of Behcet patients (rs = 0.627, P < 0.0001). IL-18 and TNF-alpha levels may be related to disease pathogenesis. Increased levels of IL-18 also support Th1 predominance in Behcet's disease.     

Periungual capillaroscopic aspects in Beh?et's disease. Apropos of 30 cases

Nailed capillaroscopy was systematically performed in 30 patients with Behcet's disease to search capillary dystrophies with paradoxal normal number of capillary loops; some indirect signs of microvascular disease were noted: pallor of the background; petechiae; sludge; abnormal visibility of the venous plexus and of irregularly arranged venules. Eight patients had a normal capillaroscopy: thirteen had direct signs of microvalvular abnormalities (nine cases with two direct signs and at least two indirect signs; and four cases with two direct and one indirect, or one direct and three indirect signs). Nine patients had only sludge and/or petechiae. We never observed any abnormality in the number of the capillaries, in the sweat droplets nor in the circulatory speed. Two patients had megacapillaries resembling those seen in scleroderma. The petechiae were observed in 50 p. 100 of the cases. We found no correlation between the capillaroscopic abnormalities and the age, sex, duration of the disease, or ethnic background. However, the presence of aphthosis the day of the capillaroscopy seems to be correlated with the cutaneous microvascular abnormalities. Thus, there exist frequent capillaroscopic abnormalities in Behcet's disease. Although aspecific, they point out the vascular tropism of this disease, resembling that of the vascularite. The prognostic importance of the capillaroscopy in Behcet's disease is under study.     

The importance of serum creatine phosphokinase level in the early diagnosis, and as a prognostic factor, of Vibrio vulnificus infection

BACKGROUND: Vibrio vulnificus infection causes rapidly progressive skin lesions and sepsis in compromised hosts with liver cirrhosis, and is often fatal. Early diagnosis and rapid treatment are important. OBJECTIVES: To clarify the characteristics of V. vulnificus infection that distinguish it from other cutaneous and soft-tissue bacterial infections and to confirm that serum creatine phosphokinase (CPK) levels are useful in early diagnosis, and are a prognostic factor for, V. vulnificus infection. METHODS: We analysed the clinical and laboratory findings (especially serum CPK levels) in eight patients with V. vulnificus infection who were treated at the Saga Medical School Hospital between January 1989 and December 1999. RESULTS: All eight patients had liver dysfunction and typical skin manifestations. Six had eaten raw seafood before onset. Seven patients had initial skin manifestations in their legs or feet and eventually died, despite prompt therapy in the intensive care unit. CPK levels of six of these seven patients were already elevated at their initial presentation. Only one patient, with skin manifestations solely on his left hand, showed and maintained a normal CPK level and survived. In 23 patients with cutaneous and soft-tissue infections (10 with necrotizing fasciitis, three with erysipelas, 10 with cellulitis), only three patients with necrotizing fasciitis and streptococcal toxic shock syndrome (STSS) showed CPK elevation. CONCLUSIONS: A high level of serum CPK in cutaneous or soft-tissue bacterial infection is considered useful for an early diagnosis of V. vulnificus infection and STSS. A history of eating raw seafood, underlying liver disease and multiple lesions suggest a diagnosis of V. vulnificus infection, rather than STSS.