坏疽性脓皮病19例临床分析

A clinical study of 19 cases with pyoderma gangrenosum

目的:探讨坏疽性脓皮病的临床特点,总结该病的并发症、治疗及预后。方法:回顾性分析1988年至2014年我院19例坏疽性脓皮病住院患者的临床资料并电话随访预后。结果:19例患者中男女比为8∶11。皮损分布特点15例有2处以上皮损,16例有小腿皮损,7例有足部皮损。8例合并相关疾病,2例合并血液系统疾病并死亡,3例肺部侵犯患者中1例死亡1例复发。所有病例使用糖皮质激素及外用药物治疗,其中5例联合免疫抑制剂治疗,3例联合采用大剂量丙种球蛋白治疗,部分患者联合了其他治疗方法。19例患者随访成功11例,2例死亡,2例复发自行去他院治疗,痊愈7例。结论:坏疽性脓皮病经常合并系统性疾病,尤其需要注意血液和肺部等系统检查,治疗以皮质类固醇激素为主,早期可采用大剂量丙种球蛋白控制,后期需要激素联合免疫抑制剂长期维持。

Objective： To analyze clinical features of pyoderma gangrenosum（ PG）, and summarize complications,treatment and prognosis of PG. Methods： The clinical data of 19 patients with pyoderma gangrenosum from 1988 to 2014 were analyzed retrospectively. The results of prognosis were collected by telophone call. Results： That the male / female ratio in the 19 patients was 8 /11. Total 15 patients had more than 2 lesions.There were 16 cases with lesions in shanks,7 cases with lesions in feet. There were 8 cases with complications or related systemic diseases. The results of prognosis showed that 2 patients complicated with blood diseases died.Total 3 patients showed the lung involvment of PG,and one patient died and one suffured from relapse. All patients were treated with glucocorticoids and topical medicines,and 5 patients were also treated with immunosuppressors.The large dose intravenous immunoglobulin（ IVIG） was also used to treat 3 patinets. The prognosis data of 11 patients were collected successfully. 2 cases died,and 2 cases suffered from relapse,and 7 cases were cured.Conclusion： PG often appear in complicating with systemic diseases,and it is important to pay more attenttion to blood system and lung. Glucocorticoid is the first-line drug to treat PG. IVIG shows a good therapeutic effect to control PG in ealy stage,but it is necessary to use glucocorticoids combined with immunosuppressors to prevent PG relapse for a long time.