早发型和晚发型寻常性银屑病307例临床资料分析

Clinical Analysis of typeⅠand typeⅡ psoriasis vulgaris

目的:探讨寻常性银屑病早发型和晚发型与家族史、发病季节、病情严重度、性别和发病部位的关系。方法:采用调查问卷形式对307例寻常性银屑病患者进行调查。结果:①早发型患者阳性家族史率(33.18%)高于晚发型(12.90%),有家族史者的初发病年龄[(28.16±11.98)岁]早于无家族史者[(34.96±16.04)岁](P<0.01)。②早发型的高发季节是冬春季,夏季最低;晚发型为春季,其次是夏季和秋季,冬季最少,差异有统计学意义(P<0.05)。③平均银屑病皮损面积和严重度指数(PASI)评分:早发型高于晚发型(P<0.05),且男低于女(P<0.05),晚发型男女差别无统计学意义(P>0.05);有家族史者高于无家族史者(P<0.05),早发型家族史者高于晚发型家族史者(P<0.01)。④头皮、小腿、前臂和肘部等为最常见的初发部位,好发部位则以头部、四肢伸侧、背部、胸腹部等为多,尤其是外耳部(72.31%)、胫前(71.66%,)和头顶(71.01%),而外生殖器、手掌、舌、跖部等处则较少有皮损发生。⑤初发部位为臀、踝关节和腹股沟的频率为晚发型高于早发型(P<0.01),肘部为早发型高于晚发型(P<0.05);外耳部、胫前、背部、前发际、腹部、面部、颈部、甲、舌等处的皮损发生率是早发型高于晚发型(P<0.05或0.01),而足背和踝关节则是晚发型高于早发型(P<0.01),其他部位两型差异无统计学意义。结论:寻常性银屑病早发型和晚发型在家族史、发病季节、病情严重度以及皮损初发和好发部位等方面存在差异,早发型患者女性重于男性,有家族史者重于无家族史者。

Objective： To investigate the differences between type Ⅰ and type Ⅱ psoriasis vulgaris in the family history, season of onset, disease severity, sex and localization of lesions. Methods： Three hundred and seven patients with psoriasis vulgaris were studied by the questionnaire. Results： （1） Patients of type Ⅰ（33.18%） were found to have higher rate of positive family history than that of type Ⅱ （12.90%）, and the mean age of onset in patients with positive family history [（28.16±11.98）age] were earlier than those without family history [（34.96±16.04）age] （P〈 0.01）. （2） In the type Ⅰ patients the onset was mostly taken place in winter and spring, with the least in summer; but in type Ⅱ patients eruption mostly occurred in spring, then followed by in summer and autumn, with the least in winter. There was a significant difference between the two types （P 〈 0.05）, （3） the mean value of PASI was higher in type Ⅰ group than that in type Ⅱ group （P〈 0.05）. Within the type Ⅰ group, it was also higher in the female than that in the male, but no significant difference was found within the type Ⅱ group （P 〉 0.05）. It was also found that mean value of PAS1 was higher in the patients with positive family history than those with negative family history （P 〈 0.05）. Concerning positive family history of psoriasis, it was higher in type Ⅰ group than that in type Ⅱ （P〈0.01）. （4） Location of the primary psoriatic lesions were capitally on scalp, leg, forearm and elbow. But predilection sites were on the head, limbs stretched side, back, chest and abdomen and so on, especially in the external ear （72.31%）, extensor aspect of leg （71.66%） and the top of the head （71.01%）, but the external genitalia, palm, tongue, footplate only had very few lesions, （5） in the type Ⅱ group the predilection sites was found mostly on buttocks, ankle, groin, and dorsum of foot （P〈 0.01）. However, in type Ⅱ group, it was found more frequent on elbow, external ear, extensor aspect of leg, back, anterior hair line, abdomen, face, neck, nails and tongue （P〈 0.05 or 0.01）. Conclusion： Type Ⅰ and type Ⅱ of psoriasis vulgaris are different in family history, onset season, the severity of disease and predilection sites. In type Ⅰ group the eruption could be more serious in female. Also, the lesion could be more severe if having a positive family history.