胫前粘液性水肿的临床诊治

Clinical management of pretibial myxedema

胫前粘液性水肿是Graves病的少见临床表现,其临床特征为双侧胫前或足背对称性非凹陷性皮肤增厚伴一个或多个皮肤硬结。胫前粘液性水肿是由于皮肤成纤维细胞在细胞因子的刺激下大量分泌的氨基葡聚糖(特别是透明质酸)在真皮内聚集所致,其发病机制可能与特异性识别TSH受体的抗体或T细胞所诱导的炎症刺激成纤维细胞合成氨基葡聚糖增多有关。Grave病患者维持正常的甲状腺功能、避免外伤、戒烟、减轻体重等可能对胫前粘液性水肿有一定的预防作用,皮下局部注射糖皮质激素或局部外用糖皮质激素软膏可有效缓解皮损,副作用小。

Pretibial myxedema is an infrequent manifestation of Graves＇ disease. It is characterized by nonpitting scaly thicken- ing with one or more skin indurations which are most frequently located over the lower legs, especially the pretibial areas or the dorsum of foot. Pretibial myxedema is resulted from the accumulation in the dermis of glycosaminoglycans secreted by fibroblasts under the stim- ulation of cytokines. The pathogenesis may be related with TSH-receptor antibodies and/or antigen specific T cells. They initiate the in- flammatory response and stimulate the production of glycosaminoglycans. Treatment includes the minimization of risk factors such as to- bacco, weight and thyroid function. Long-acting glucocorticid injection subcutaneously or topical application of a glucocortieid ointment is effective and well tolerated.