45例结核菌素试验阳性的结节性红斑回顾性临床分析

目的:探讨结核菌素试验阳性的结节性红斑的可能诱因和临床特点。方法:回顾性分析45例结核菌素试验阳性的结节性红斑的临床和实验室资料。结果:45例患者均具有典型的结节性红斑皮损,PPD试验阳性或强阳性;男女之比为1∶4.5,平均年龄34.5岁,平均病程1.2年。45例X光胸片检查合并肺结核6例(13.4%),淋巴结核4例(8.9%),胸膜炎4例(8.9%),肺部阴影灶8例(17.8%);无异常者23例(51.1%)。实验室检查:45例中血沉增快32例,抗"O"阳性2例,Ig G较正常升高3例,类风湿因子阳性2例,痰菌涂片阳性1例,其余各项均为阴性。结论:结节性红斑病因复杂,结核菌感染是原因之一。对结核菌素试验阳性的结节性红斑,抗结核药联合糖皮质激素治疗有良好的临床疗效。     

Rowell综合征

报告6例Rowell综合征,其中男1例,女5例,年龄14～35岁.皮损表现为全身(尤其是曝光部位)散在分布的靶形红斑.实验室检查:6例患者的抗核抗体(ANA)均阳性,其中斑点型3例、斑点一核仁型2例和均质-斑点型1例.2例类风湿因子(RF)阳性,5例抗Ro抗体阳性,2例抗La抗体阳性.皮损组织病理表现为表皮角化过度,角质形成细胞坏死,基底层点状液化变性.真皮浅层血管周围有炎性细胞浸润.6例均符合Rowell综合征的诊断标准.临床上该病主要需与系统性红斑狼疮(SLE)、亚急性皮肤型红斑狼疮(SCLE)和多形红斑鉴别.     

大疱性系统性红斑狼疮一例

患者,女,27岁。咳嗽4个月,躯干、四肢红斑、水疱及脱发2个月。皮肤科情况:头顶发稀疏,面部充血性红斑,双手指腹红斑,躯干四肢可见大小不等水疱、血疱,疱壁紧张,尼氏征阴性。外周血红细胞和血红蛋白下降、补体下降,ANA、抗ds-DNA阳性,血清抗VII胶原抗体阳性。患者疱液免疫检测:ANA、抗ds-DNA、抗SSA、抗SSB、抗组蛋白抗体(+),抗RO 52抗体(+++),抗核小体抗体(++),滴度与血液中滴度平行。诊断为大疱性系统性红斑狼疮。     

表现为环状红斑水疱的大疱性系统性红斑狼疮一例

45岁女性患者,躯干及四肢红斑、水疱伴痒痛20余天。皮损表现为躯干、上肢对称分布大小不等的类圆形或同心圆状红斑、丘疹及水疱,尼氏征阴性;双下肢及双手足背侧可见界限清楚的水肿性红斑,口腔及生殖器黏膜未受累。抗核抗体(ANA)、SSA抗体、Ro-52抗体、抗心磷脂抗体均阳性,U1RNP/sm抗体、Sm抗体弱阳性;补体C3、C4降低;间接免疫荧光示基膜带抗类天疱疮抗体阳性。诊断:大疱性系统性红斑狼疮。给予糖皮质激素及硫酸羟氯喹治疗后病情好转。     

伴持续性毛细血管扩张和痉挛性下肢轻瘫的新生儿红斑狼疮

报告1例男5岁白人新生儿红斑狼疮(NLE)患儿,出生时有泛发环状红斑和散在毛细血管扩张,血小板明显减少(24×10~9/L)、ANA阳性(IgG滴度1:256)、抗Ro及抗La抗体亦为阳性,其母亦有相同类型的抗体。环状皮损病理显示表皮基底层广泛空泡变性,真皮上部淋巴细胞浸润,免疫荧光检     

系统性红斑狼疮两家系4例

例1.男,46岁。面部起蝶形红斑,日晒后加重2年,于1994年5月25日入院。入院前2年,面部持续有蝶形红斑,且出现关节痛、口腔溃疡、脱发。尿蛋白( ),血狼疮细胞阳性,考虑为系统性红斑狼疮(SLE),给予泼尼松45mg/d治疗,病情好转。入院前半年患者自行停药,病情复发且加重。入院前3周复查尿蛋白( )、尿糖( )、尿潜血( )。皮肤科检查:面部见蝶形红斑,颈部、胸前见V字形红斑,狼疮发。实验室检查:血沉74mm/1h,白细胞3.4×109/L,尿蛋白( )、尿糖( ),尿蛋白定量为5.367g/24h(10￣150mg/24h),狼疮细胞阴性,抗核抗体(ANA)阳性,滴度为1∶80。诊断:…     

系统性红斑狼疮患者抗SSB抗体阳性和阴性患者的对比分析

目的分析探讨系统性红斑狼疮(Systemic Lupus Erythematosus,SLE)患者抗SSB抗体阳性和SSB抗体阴性对临床表现、实验室指标、治疗及疗效的影响,为更深入研究疾病的发展提供线索。方法采用回顾性调查方法,按不同性别、年龄[育龄期(15~49)岁,育龄期后≥50岁]分析l00名抗SSB抗体阳性及阴性的系统性红斑狼疮患者的临床表现、实验室检查、治疗及疗效的关系。结果 SLE患者中以育龄期女性为多,平均年龄28.6岁。汉族占88%。抗SSB抗体阳性的SLE患者蝶形红斑、抗ds-DNA抗体(+)、外周血中性粒细胞减少的比率明显高于抗SSB抗体阴性的SLE患者。结论抗SSB抗体阳性的SLE患者发生面部蝶形红斑、外周血中性粒细胞减少及抗ds-DNA抗体阳性的机率高于抗SSB抗体阴性的的患者。     

大疱性系统性红斑狼疮一例

65岁女性患者,全身红斑、水疱伴瘙痒1个月。面部、躯干、四肢散在分布暗红斑,红斑基础上可见松弛性水疱或大疱,尼氏征阴性,口腔颊黏膜散在浅表糜烂。左肩部新发红斑处皮损组织病理:表皮下裂隙、水疱形成,疱内少量嗜酸粒细胞及真皮浅层淋巴细胞、中性粒细胞浸润。直接免疫荧光可见Ig A、Ig G和补体C3在表皮下呈线状沉积。间接免疫荧光显示抗基膜带抗体阳性(滴度1:80)。左面颊皮损组织病理:表皮萎缩变薄,表真皮分离,真皮浅中层血管扩张,周围散在淋巴细胞为主的炎性细胞浸润,胶原嗜碱变性。抗核抗体(ANA)阳性(1:320);Sm抗体阳性;动态红细胞沉降率60 mm/h;补体C3 0.59 g/L,C1q 129 mg/L。诊断:大疱性系统性红斑狼疮。经甲泼尼龙联合硫酸羟氯喹治疗2周后好转出院,随访6个月无复发。     

不同剂量糖皮质激素治疗系统性红斑狼疮的探讨

目的:探讨小剂量糖皮质激素冲击和常规剂量糖皮质激素治疗系统性红斑狼疮(SLE)的疗效及适应证。方法:用小剂量糖皮质激素冲击治疗103例SLE患者,常规剂量糖皮质激素治疗98例SLE患者。3周后观察两组患者临床症状缓解时间、各项实验室检查指标的好转率及不良反应。结果:两组患者部分临床症状缓解时间、实验室检查指标的好转率及不良反应发生率经统计学分析差异有显著性(P<0.05)。结论:小剂量糖皮质激素冲击治疗SLE患者的关节疼痛、发热、蛋白尿的疗效优于常规剂量治疗,而常规剂量糖皮质激素治疗甲周红斑、口腔溃疡、抗ds-DNA抗体阳性、抗核抗体(ANA)阳性、低血红蛋白的疗效优于小剂量糖皮质激素冲击治疗。两种方法治疗蝶形红斑和血小板、白细胞、红细胞减少,C3、C4降低的疗效差异无显著性(P>0.05)。     

以掌部红斑为首发表现的系统性红斑狼疮

报告1例以掌部红斑为首发表现的系统性红斑狼疮(SLE)。患者女,34岁。因双掌部反复红斑伴疼痛6个月,溃疡1周就诊,并发脱发及光敏现象。实验室检查:贫血,淋巴细胞减少,尿蛋白、补体下降,抗核抗体(ANA)及抗双链(ds)-DNA阳性。皮损组织病理检查:表皮角化过度及角栓形成,基底细胞层液化变性;真皮浅、中层血管扩张,部分血管壁纤维素样坏死,周围少量淋巴组织细胞浸润及核尘。直接免疫荧光检查:基膜Ig G、Ig A及Ig M呈线状沉积。诊断为SLE。     

IgG reactivity against non-conformational NH-terminal epitopes of the desmoglein 3 ectodomain relates to clinical activity and phenotype of pemphigus vulgaris

Pemphigus vulgaris (PV) is an autoimmune disease caused by immunoglobulin G (IgG) autoantibodies against the desmosomal adhesion molecules, desmoglein (Dsg)3 and Dsg1. The aim of the study was to relate IgG reactivity of 123 PV sera and 40 control sera against NH(2)-terminal non-conformational epitopes of Dsg3 and Dsg1 with disease activity and clinical phenotype by enzyme-linked immunosorbent assay. The results show that (i) the overall reactivity and the titres of IgG reactive with the Dsg3 ectodomain, Dsg3(1-566), significantly correlated with the disease activity of the PV patients; (ii) IgG reactivity against the NH(2)-terminus of Dsg3, Dsg3(1-161), was associated with active PV while there was no direct correlation between the IgG titres and the disease activity; (iii) IgG reactivity against the NH(2)-terminus of Dsg3, Dsg3(1-161), was associated with mucosal and mucocutaneous PV; (iv) IgG titres against a small stretch of the NH(2)-terminus of Dsg3, Dsg3(25-88), were associated with active PV; and (v) IgG in the PV sera detected non-conformational epitopes in addition to the previously identified conformation-dependent epitopes of the Dsg3 and Dsg1 ectodomains.     

Clinical relevance of serum levels of matrix metallopeptidase-2, and tissue inhibitor of metalloproteinase-1 and -2 in patients with malignant melanoma

The interaction and/or balance between matrix metallopeptidase (MMP)-2 and tissue inhibitor of metalloproteinase (TIMP)-2 in vivo may play important roles in the process of tumor growth, invasion and metastasis of malignant melanoma. In this study, we investigated the serum levels and immunohistochemical expression of MMP-2, TIMP-1 and TIMP-2 in patients with melanoma and analyzed the correlation with clinicopathological parameters. The level of serum MMP-2 in patients was significantly higher than that of the control. Moreover, the level of MMP-2 was significantly higher than that of the control in patients who were: (i) female; (ii) pT1 and pT4; (iii) with and without lymph node (LN) metastasis; (iv) in stage I and stage IV; (v) with and without recurrence; and (v) alive and dead. The level of serum TIMP-1 in patients with melanoma was significantly higher than that of the control. Among melanoma patients, the level of TIMP-1 with pT4 was significantly higher for patients who were: (i) pT1 and pT3; (ii) with LN metastasis (vs those without); (iii) in stage IV (vs those in stages I, II and III); and (iv) dead (vs those alive). The level of serum TIMP-2 in patients with melanoma was not different from the control. However, the level of TIMP-2 in patients with pT4 was significantly higher than for patients who were: (i) pT1, pT3 and control; (ii) with LN metastasis (vs those without metastasis and control); (iii) with stage IV (vs those in stages I and II and control); (iv) in recurrence (vs control); and (v) dead (vs those alive and control). These results suggest that increased serum levels of TIMP-1 and TIMP-2 reflected the extent of metastatic melanoma lesions, and that serum levels of TIMP-1 may be a new useful marker for melanoma progression.     

Eczema of the Face,Scalp and Neck: An Epidemiological Comparison by Site

Fifteen percent of 3684 patients with eczema attending a contact clinic presented with head and/or neck eczema. There were epidemiological differences among eczema rashes occurring on different parts of the head and neck. Of the 538 patients with head and/or neck eczema, 345 (64%) occurred solely on the face, 52 (10%) on the eyelids, 49 (9%) on the lips, 20 (4%) on the ears, 22 (4%) on the scalp, and 21 (4%) on the neck. Twenty-nine (5%) had eczema on more than one area of the head/neck. The mean age was lowest in patients with lip eczema (27.5 years) and highest in patients with eyelid eczema (37 years) (p=0.0056). The proportion of females with eczema was higher than males in all groups except the scalp eczema group. Contact dermatitis was more prevalent in the ear eczema (80%) and neck eczema (76%) groups, while endogenous/unclassifiable eczema was more prevalent in the lip eczema (72%) and scalp eczema (73%) groups (p<0.0001). Allergic contact dermatitis was more common than irritant contact dermatitis.     

Pityriasis lichenoides: the differences between children and adults

BACKGROUND: Pityriasis lichenoides (PL) is a skin disease that affects both children and adults. Anecdotally, it is said to run a more benign course in children, with a frequent tendency to self-resolution. However, to our knowledge, there have been no published studies comparing PL in both age groups. OBJECTIVE: To evaluate the clinicopathological features, overall efficacy of treatments and disease outcomes in children and adults diagnosed with PL. METHODS: A retrospective review of records was undertaken on all patients diagnosed with PL at two regional centres during an 8-year period (from 1998 to 2006). For each individual, data were collected on age, sex, number of lesions, lesional morphology and distribution, symptoms, histopathological features, treatment modalities (and response), overall follow-up and length of remission. RESULTS: We recorded 25 children (median age 8 years, range 2-18) and 32 adults (median age 40 years, range 20-65) with PL. All the children and adults had more than 20 scaly, papular lesions. Children had greater lesional body involvement than adults. Lesions on the legs and trunk were present in 23 children (92%) compared with 19 adults (59%) (P < 0.01) and facial involvement was observed more commonly in children (n = 10, 40%) compared with adults (n = 8, 25%). Dyspigmentation was significantly more common in children (n = 18, 72%) compared with adults (n = 6, 19%) (P < 0.001). Topical corticosteroids were used by 16 children (64%) and 18 adults (56%) but only half in each group found these effective. Eight children (32%) were treated with erythromycin, with only two (25%) clearing, and one of these subsequently relapsing. In contrast, four adults (13%) received antibiotics, with three (75%) clearing and none relapsing thereafter. Ultraviolet B phototherapy was used in eight children (32%), with seven (88%) completely or almost clearing, but four (57%) subsequently relapsed. Fourteen adults (44%) received phototherapy; 10 (71%) completely cleared and only two of these (20%) subsequently relapsed. Strikingly, after a median disease duration of 30 months, only five children (20%) went into complete remission compared with 25 adults (78%) (P < 0.001). CONCLUSIONS: This is the first study to compare PL in children and adults. Our findings suggest that, compared with adults, PL in children is more likely to run an unremitting course, with greater lesional distribution, more dyspigmentation and a poorer response to conventional treatment modalities.     

Pathophysiology of nocturnal scratching in childhood atopic dermatitis: the role of brain-derived neurotrophic factor and substance P

BACKGROUND: Childhood atopic dermatitis (AD) is a distressing disease associated with pruritus and sleep disturbance. The pathophysiology of pruritus is complex and various neuropeptides may be involved. OBJECTIVE: To evaluate whether or not brain-derived neurotrophic factor (BDNF) and substance P are associated with disease severity, quality of life and nocturnal scratching in AD. METHODS: Patients with AD aged under 18 years were recruited. Disease severity was assessed with the SCORing Atopic Dermatitis (SCORAD) index, and quality of life with the Children's Dermatology Life Quality Index (CDLQI). Concentrations of plasma BDNF, substance P, AD-associated chemokines [cutaneous T-cell attracting cytokine (CTACK), thymus and activation regulated chemokine (TARC)], serum total IgE and eosinophil counts were measured in these patients. All children were instructed to wear the DigiTrac monitor on their dominant wrist while sleeping. The monitor was programmed to record limb motion between 22.00 and 08.00 h the following morning. RESULTS: Twenty-eight children with AD [mean (SD) age 11.1 (3.3) years] were recruited. The mean (SD) SCORAD was 48.1 (21.5) and CDLQI was 8.7 (5.4) in the patients with AD. Their mean (SD) plasma concentrations of BDNF, substance P, CTACK and TARC were 1798 (935), 94 (42), 1424 (719) and 824 (1000) pg mL(-1), respectively. BDNF was significantly correlated with SCORAD (r = 0.478, P = 0.010) and CDLQI (r = 0.522, P = 0.004), whereas substance P showed significant correlation only with CDLQI (r = 0.441, P = 0.019). BDNF and substance P were also significantly correlated with the average (r = 0.905, P < 0.001 and r = 0.925, P < 0.001) and frequency-specific (r = 0.826, P < 0.001 and r = 0.870, P < 0.001) nocturnal wrist activities measured by DigiTrac. However, there was no correlation between BDNF or substance P and the subjective symptoms of pruritus or sleep-loss scores as reported by the parents in the SCORAD. In contrast, serum total IgE levels showed significant correlations with the subjective symptoms of pruritus (r = 0.576, P = 0.001) and sleep loss (r = 0.419, P = 0.027). CONCLUSIONS: Serum levels of BDNF and substance P correlate with the clinical score and quality of life score in patients with AD. The strong correlations with nocturnal wrist movements suggest that they may be the pathogenic factors of the annoying symptoms of scratching.     

Clinical evaluation of scleroderma spectrum disorders using a points system

We have established a new diagnostic method using a points system to evaluate patients with early scleroderma and those with scleroderma spectrum disorders (SSD). To examine the clinical usefulness of this method, it was applied to a total of 215 cases including 97 patients with scleroderma, 32 with SSD, 28 with presumed primary Raynaud's phenomenon (RP) and 58 with other connective tissue disorders (CTD). A total score was obtained for each patient as the sum of the following five factors: (1) extent of skin sclerosis (maximum, 10 points); (2) pulmonary changes (maximum, 4 points); (3) antinuclear antibodies (maximum, 5 points); (4) pattern of Raynaud's phenomenon (maximum, 3 points); and (5) nailfold bleeding (maximum, 2 points). Of the 97 scleroderma patients, 86 (89%) had 9 or more points, and of the 32 SSD patients, 28 (88%) had 5 to 8 points. In contrast, all patients with presumed primary RP and 54 of 58 (93%) patients with other CTD had 0 to 4 points. These data suggest that this diagnostic method is very useful not only for clinical evaluation of SSD, but also for the differentiation of scleroderma and SSD from other CTD and primary RP.     

桥粒芯蛋白1酶联免疫吸附试验检测落叶型天疱疮血清抗体的评价

目的 探讨桥粒芯蛋白1（Dsg1）酶联免疫吸附试验（ELISA）检测落叶型天疱疮（PF）血清学抗体的意义。方法 将80例PF患者和132例对照人群的血清标本进行编盲,用ELISA法检测所有标本中抗Dsg1自身抗体,同时应用间接免疫荧光（IIF）法检测所有标本的抗体滴度,操作过程为随机检测,最后将两方法的结果进行比较。结果 75例PF患者和5例对照人群（包括1例不确定值,大疱性类天疱疮、SLE、皮肌炎、湿疹及健康者各1例）Dsg1 ELISA为阳性,71例PF患者和0例对照人群IIF为阳性。Dsg1 ELISA的敏感性为93.8%（95%可信区间0.85 ~ 0.98）,特异性为96.2%（95%可信区间0.91 ~ 0.99）。IIF的敏感性为88.8%（95%可信区间0.82 ~ 0.96）,特异性为100%（95%可信区间0.96 ~ 1.00）。两者相比,敏感性（P = 0.289）和特异性（P = 1.000）差异均无统计学意义。结论 Dsg1 ELISA是一种简便、敏感、特异的血清学检测方法,可作为诊断PF的一种辅助手段。     

性病门诊235例患者生殖支原体感染分析

目的研究分析我院皮肤性病门诊患者生殖支原体(Mg)的感染情况。方法收集2015年2—10月就诊于皮肤性病门诊疑似泌尿生殖系统感染的患者235例(男165例,女70例),采集男性尿道或女性宫颈分泌物分别进行超显微镜检、淋球菌培养、支原体培养、生殖道沙眼衣原体聚合酶链反应(PCR)检测和生殖支原体实时荧光核酸恒温扩增检测技术(SAT)检测。结果 235例患者中各种微生物检出情况分别为Mg 17例(7.23%),解脲脲原体(Uu)72例(30.64%),人型支原体(Mh)22例(9.36%),生殖道沙眼衣原体(Ct)10例(4.26%),淋球菌6例(2.55%),上述检测项目全部阴性122例(51.91%)。Mg阳性的17例患者中单一感染7例(41.18%),混合感染10例(58.82%),其中Mg+Uu感染6例,Mg+Uu+Mh感染4例。结论 Mg可单一感染,也可混合感染,临床上应加强对性病门诊患者Mg的筛查。Mg生长条件要求高,培养成功率低,SAT检测是目前可以选择用来检测Mg的方法之一。     

Childhood cutaneous tuberculosis: a study over 25 years from northern India

AIMS: We undertook this study to analyse the pattern of childhood cutaneous tuberculosis prevailing in northern India over the past 25 years and to highlight differences from and similarities to adult tuberculosis. MATERIALS AND METHODS: Clinical records of children with cutaneous tuberculosis who attended the Nehru Hospital attached to the Postgraduate Institute of Medical Education and Research, Chandigarh, India, between January 1975 to December 1999 were analysed. RESULTS: Four hundred and two patients with cutaneous tuberculosis were examined during the 25-year period of observation. These patients formed 0.1% of the total dermatology outpatients. Seventy-five (18.7%) of these 402 cases were children ( 10 mm). Histopathologic reports were available for evaluation in all 75 children. Out of 30 cases of LV, 24 (80%) showed classical tuberculous histology. In contrast, out of 40 cases with SFD, only 19 (47.5%) showed classical histology. Classical tuberculous histology was noted in all 3 (100%) cases of TVC and 1 (100%) case each with tuberculids and gumma. Tubercle bacilli could be demonstrated in 4/30 (13.3%) cases with LV and 9/40 (22.5%) cases with SFD. Systemic involvement was seen in 16 (21.3%) children, of whom 3 (18.8%) had LV and 13 (81.3%) SFD. The lungs were the most common organs involved in 8 (50.0%) children followed by bone(s) in 4 (25.0%), abdomen in 2 (12.5%), and both lung and bone in 1 (6.3%) child. In contrast to adults, girls outnumbered boys in the childhood series; SFD was a common form of presentation in contrast to LV and TVC, tuberculous gumma and tuberculids were noted less often. In both children and adults, Mantoux reactivity did not correlate with the extent of the disease; patients with disseminated disease were found to be less often vaccinated with BCG and regional lymphadenopathy was noted more often in patients with disseminated disease. CONCLUSIONS: In the whole spectrum of cutaneous tuberculosis, there is a proportion of patients with dissemination (systemic involvement) who are of great epidemiological significance as they require a change in the standard therapeutic regimens recommended for cutaneous tuberculosis.     

急性心肌梗死患者血清sLOX-1、CK-MB水平及意义

目的探讨急性心肌梗死(AMI)患者血清可溶性凝集素样氧化型低密度脂蛋白受体-1(sLOX-1)和心肌型肌酸激酶同工酶(CK-MB)水平及意义。方法选取AMI患者120例(AMI组),同时选取健康体检者120例作为对照组,检测血清sLOX-1、CK-MB水平。结果AMI组患者血清sLOX-1、CK-MB水平明显高于对照组(P<0.05);AMI组左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)和左室射血分数(LVEF)分别为(73.39±2.29)mL/m^2、(38.83±9.28)mL/m^2和(47.88±8.29)%;血清sLOX-1、CK-MB与LVEDVI、LVESVI和LVEF未见明显相关性(P>0.05);AMI组重度狭窄患者血清sLOX-1、CK-MB明显高于轻度和中度狭窄患者(P<0.05);中度狭窄患者血清sLOX-1、CK-MB明显高于轻度狭窄患者(P<0.05);血清sLOX-1、CK-MB与Gensini评分呈正相关(G=0.339和0.252,P<0.05),血清sLOX-1与CK-MB呈正相关(r=0.301,P<0.05)。结论急性心肌梗死患者血清SLOX-1、CK-MB水平升高,与冠状动脉狭窄程度有一定相关性。