累及皮肤的结节病35例临床分析

The clinical analysis of 35 patients with cutaneous sarcoidosis

目的 总结分析累及皮肤的结节病的临床特点.方法 回顾性分析北京协和医院1980-2009年35例累及皮肤的结节病患者的临床资料,按有无皮肤外其他系统受累分为单纯皮肤结节病组（简称皮肤组）与合并其他系统受累的皮肤结节病组（简称系统组）.结果 （1）35例患者男女之比1：3.38,发病年龄（47.5±10.0）岁,皮肤组（41.8±12.5）岁,系统组（50.5±7.1）岁.（2）皮肤损害分布以四肢最为多见,皮肤损害类型以皮下结节最为多见,其次是斑丘疹和结节红斑.（3）皮肤外系统受累以肺、关节和淋巴结最为多见,与国外全身结节病资料相比,肺受累率偏低,而关节、淋巴结、肾脏、肌肉、神经系统受累率较高.（4）在系统组中,乏力和体重减轻的发生率明显高于皮肤组（P＜0.05）;ESR、C反应蛋白、类风湿因子高于皮肤组（P＜0.05）.系统组患者糖皮质激素的使用率（95.7%）高于皮肤组（66.7%,P＜0.05）.结论 累及皮肤的结节病皮肤损害以皮下结节最为多见,肺受累率低,有系统受累者平均发病年龄、炎性指标水平及糖皮质激素使用率均较无系统受累者高.

Objective To investigate clinical features of cutaneous sarcoidosis. Methods A retrospective analysis was carried out based on the clinic data of 35 patients with cutaneous sarcoidosis who were hospitalized in Peking Union Medical College Hospital during 1980-2009. They were divided into two groups, the group without systemic involvement （skin group ）and the group with systemic involvement （ systemic group）. Results （ 1 ） The ratio of men and women with cutaneous sarcoidosis was 1： 3. 38, and the average incident age was （47. 5 ± 10. 0） years old. The average incident age of skin group and systemic group were （41.8 ± 12.5 ） years old and （ 50. 5 ± 7. 1 ） years old, respectively. （2） The most common skin manifestation was subcutaneous nodule, followed by maculopapule and erythema nodosa. The most common involved sites were limbs. （3） The common involved systems extra-skin included the lung, joints and lymph nodes. The involvement rate of lung in cutaneous sarcoidosis of our present data was lower than those of foreign reports. However, the involvement rates of joints, lymph nodes, kidney, muscles and nervous system showed higher in our data. （4） The incidences of fatigue and weight loss in systemic group were higher than those in skin group （ P 〈 0. 05 ）. The indexes of erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor in systemic group were higher than those in skin group （ P 〈 0. 05 ）. More patients in systemic group were treated with corticosteroid than that in skin group （ 95.7% vs 66.7%, P 〈 0. 05 ）.Conclusions Subcutaneous nodules are the most common and the involvement rate of lung is lower in cutaneous sarcoidosis of our present data. Compared to the patients without systemic involvement, the average incident age of systemic ones is older, the indexes of inflammation markers and the usage of corticosteroid are higher.