自身免疫性风湿病患者皮肤溃疡的临床特点与治疗策略

Skin ulcers in autoimmune rheumatic disorders:a pilot study of their clinical features and management strategies

目的研究自身免疫性风湿病(ARDs)合并皮肤溃疡患者的临床特点,治疗方法和效果。方法回顾性调查1998年至2008年中山大学附属第一医院ARDs合并皮肤溃疡住院患者的病例资料,分析ARDs患者皮肤溃疡的临床特点,各种治疗方法的效果。结果共有67例ARDs合并皮肤溃疡住院患者,126个溃疡,男女比例为1:3.1(16:51),平均年龄(50.9±19.2)岁。70%患者溃疡发生时处于疾病活动期。绝大部分患者伴有多种器官系统受累和基础疾病,其中血象改变和低白蛋白血症常见。大部分溃疡在应用糖皮质激素和缓解病情抗风湿药物控制病情活动后保守治疗愈合或好转,或通过手术修复愈合。结论ARDs患者皮肤溃疡的发生及其临床表现与ARDs本身密切相关,治疗上应首先控制ARDs病情活动,再结合全身和局部情况决定手术或非手术治疗,并辅以综合治疗。

Objective To investigate the clinical features of skin ulcers in autoimmune rheumatic disorders （ARDs） and evaluate the outcomes of various management strategies. Methods A retrospective survey was conducted on the original medical records of all hospitalized ARDs patients acompanying with skin ulcers from 1998 to 2008 in the First Affiliated Hospital of Sun Yat-sen University. The clinical features of the ulcers, its relationship with ARDs and the outcomes of various management strategies were analyzed statistically or descriptively. Results Sixty seven cases and 126 skin ulcers were involved. The ratio of male to female was 1：3.1. Patients were （50.9± 19.2） years old on average. Seventy percent of the patients were in the active phase of ARDs when ulcers occurred. Multiple organ/system disorders concurred in most of the patients. Hematological abnormality and hypoalbuminemia were common. When ARDs activity was controlled by glucocorticosteroids and disease-modifying antirheumatic drug, most ulcers could heal up or improve through conservative methods or surgical repair. Conclusions The occurrence and clinical features of skin ulcers in ARDs are closely related to ARDs＇ autoimmunity. The treatment of ulcers should be based on a satisfactory control of ARDs activity and a comprehensive support. The choice of surgical or non-invasive repair of ulcers should be based on both general and local conditions.