47例青斑血管炎临床分析

Clinical analysis of 47 cases of livedo vascniitis

目的探讨青斑血管炎患者的临床与病理特点。方法分析47例青斑血管炎患者临床资料，主要治疗措施为单纯抗凝，或抗凝联合糖皮质激素抗炎，或抗凝联合柳氮磺吡啶抗炎。结果临床表现为：皮损首先表现为瘀点或瘀斑、水肿伴胀痛，在此基础上出现点状坏死，逐渐出现虫蚀状溃疡，最后形成白色萎缩。组织病理：真皮浅层或伴真皮深层小血管壁纤维素样变性与管腔内血栓形成、受损血管周围可见稀疏淋巴细胞浸润；单纯抗凝组、抗凝联合糖皮质激素组及抗凝联合柳氮磺吡啶组的平均起效时间分别为（9．14±3．48）、（5．62±1．04）、（8．23±2．68）d，而疾病平均缓解时间分别为（2．57±1．41）、（4．06±1．51）、（5．64±1．32）个月。结论抗凝联合抗炎治疗青斑血管炎可能比单纯抗凝治疗起效更快，有利于控制复发。

Objective To assess the clinical and pathological feature of patients with livedo vasculitis. Methods Clinical data were collected from 47 patients with livedo vasculitis, and retrospectively analyzed. All the patients were classified into three groups according to treatment strategy： anticoagulation group, anticoagulation ＋ corticosteroids group, and anticoagulation ＋ sulfasalazine group. Results Clinically, livedo vasculitis usually began as petechia or ecchymosis, edema with distending pain, followed by spotty necrosis which subsequently evolved into vermiculated ulcers and, finally, atrophie blanche. Pathological features included fibrinoid degeneration of and thrombus formation in small vessel walls within the superficial or deep dermis, as well as a sparse lymphocytic infiltrate around the injured vessels. The average time to onset of action of administrated drugs was （9.14 ± 3.48）, （5.62± 1.04） and （8.23 ± 2.68） days, and time to remission was （2.57 ± 1.41）, （4.06 ±1.51） and （5.64 ± 1.32） months, in the anticoagulation group, anticoagulation ＋ corticosteroids group and anticoagulation ＋ sulfasalazine group, respectively. Conclusion Anticoagulation in combination with anti-inflammatory therapy appears to have a more rapid onset of action in the treatment of livedo vasculitis with a reduced recurrence rate compared with anticoagulation therapy alone.