红皮病型银屑病137例临床分析

Clinical analysis on 137 cases of erythrodermic psoriasis

目的总结红皮病型银屑病的临床特点和治疗经验。方法对137例红皮病型银屑病患者的临床资料进行回顾性分析。结果 137例患者平均年龄51.6岁,其中104例(75.9%)患者年龄>40岁,男女之比为5.5∶1。多种因素可诱发红皮病型银屑病,不规则应用糖皮质激素及中药、感染是其主要诱因。实验室检查显示患者有低蛋白血症及电解质紊乱等特征。137例患者单独或联合使用维A酸、甲氨喋呤、环孢素、雷公藤多甙、糖皮质激素等药物治疗,总有效率为78.1%。其中糖皮质激素治疗组41例,33例有效,有效率80.5%,非糖皮质激素治疗组96例,74例有效,有效率77.1%,2组有效率差异无统计学意义(P>0.05)。结论维A酸、甲氨喋呤、环孢素、雷公藤多甙、糖皮质激素在红皮病型银屑病治疗中的疗效肯定,但糖皮质激素可诱发脓疱型银屑病且副作用明显、复发率高,应只在病情难以控制的情况下使用。

Abstract：Objective To summarize the clinical features and effective treatment for erythrodermie psoriasis. Methods The clinical data of 137 cases of the erythrodermie psoriasis was analyzed retrospectively. Results The average age of the 137 patients was 51.6 years and 104（75.9% ） patients were over 40 years old. Sex ratio of male to female was 5.5： 1. Erythrodermie psoriasis was recorded to be triggered by varied factors, incorrect use of glucoeortieoid, traditional chineses drugs, and infections were important precipitating factors. Laboratory examination could show the characteristics of hy- poproteinemia and electrolyte disturbances. 137 patients were treated alone or in combination with tretinoin ,methotrexate, ciclosporin, tripterygium glycosides, glucocorticoid, the overall effective rate was 78.1%. Among the 41 patients of cortico- steroid treatment,33 were effective, and 74 of 96 non-corticosteroid treatment patients were effective. There was no signifi- cant difference between the two ways of treatment. Conclusion Tretinoin, methotrexate, cic]osporin, tripterygium glyco- sides and corticosteroid were effective in the treatment of erythrodermic psoriasis. Cortieosteroid should be used only when the state of illness was difficult to control, since it may induce pustular psoriasis with its significant side effects, high re- currence rate.