泛发性脓疱型银屑病血清胆红素测定的临床意义

Clinical Significance of Serum Bilirubin Measurement in Generalized Pustular Psoriasis

目的通过测定泛发性脓疱型银屑病(GPP)患者血清胆红素及非特异性炎症指标水平,探讨血清胆红素在该病发展中的临床意义。方法纳入49例GPP患者和117例对照病例,测定血清总胆红素(TB)、直接胆红素(DB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)及外周血白细胞、中性粒细胞计数、C-反应蛋白(CRP)、红细胞沉降率(ESR)水平。结果GPP患者ALT,AST,GGT和ALP异常率与对照组相比差异无统计学意义。GPP患者DB水平以及DB/TB比值显著高于对照组(P均<0.01)。GPP患者CRP,ESR,外周血白细胞和中性粒细胞计数也明显高于对照组(P<0.001)。GPP患者DB和CRP,外周血白细胞和中性粒细胞计数均呈正相关(P<0.05)。结论 DB水平可作为评估GPP患者胆汁淤积的敏感指标,对临床上评估GPP严重程度有重要参考价值;通过对GPP患者DB和外周血白细胞/中性粒细胞相关性分析,也为中性粒细胞胆管炎导致GPP胆汁淤积这一假说提供了新的佐证。

Objective Serum bilirubin and non-specific inflammatory markers in patients with generalized pustular psoriasis （GPP） were measured to investigate the clinical significance of serum biiiruhin in the progression of GPP. Methods Forty-nine GPP patients and 117 control cases were enrolled in this study. Serum total bilirubin （TB）, direct bilirubin （DB）, alanine arninotransferase （ALT）, aspartate aminotransferase （AST）, gamma glutamyl transpeptidase（GGT）, alkaline phosphatase （ALP）, peripheral blood leukocyte and neutrophil counts, C - reactive protein （CRP） and erythrocyte sedimentation rate（ESR） were measured in all patients. Results There were no statistical differences existed in the frequencies of abnormal ALT, AST, GGT and ALP between GGP patients and control patients. Serum DB level and DB/TB ratio in GPP patients were significantly higher than those in control cases（P 〈0.01 ）. Meanwhile,CRP,ESR and peripheral blood leukocyte and neutrophil counts in GGP patients were also higher than those in control cases（ P 〈 0. 001 ）. Serum DB level in GPP patients was positively correlated with serum CRP level , peripheral blood leukocyte count and neutrophil count （ P 〈 0. 05 ）. Conclusion This study confirmed that serum DB level can be used to evaluate cholestasis as a sensitive marker in GPP patients, which has a critical role in assessing the severe degree of GPP condition. Based on the correlation analysis of DB and peripheral blood leukocyte/neutrophil counts in GGP patients, it provided new evidence for the hypothesis of neutrophil cholangitis caused GPP cholestasis.