溃疡性结肠炎患者皮肤表现及影响因素分析

Clinical analysis of cutaneous manifestations and related factors in patients with ulcerative colitis

目的分析具有皮肤异常表现的溃疡性结肠炎（UC）患者皮肤损害的临床特征，探讨患者性别、年龄、吸烟史、疾病活动度、肠道病变范围与皮肤表现的相关性。方法收集1994年1月至2014年12月北京大学第一医院门诊及住院诊断为UC患者373例，所有患者均符合2012年炎症性肠病诊断与治疗的共识意见的UC诊断标准，皮肤表现均经皮肤专科医师会诊明确诊断。比较有皮肤表现UC患者与无皮肤表现UC患者之间的差异。结果373例UC患者中有皮肤表现者共34例（9．1％），包括：坏疽性脓皮病11例、结节性红斑8例、湿疹6例、银屑病3例、天疱疮2例、肉芽肿性唇炎1例、鱼鳞病1例、玫瑰痤疮1例、脓疱病1例。皮肤表现可以出现在UC明确诊断之前、之后或同时诊断（分别为3、24和7例）。有皮肤表现的患者年龄为（47．2±12．1）岁，男女比例0．79：1，伴皮肤表现UC患者的重度UC、广泛结肠型UC的比例明显高于不伴皮肤表现的UC患者[50．0％（17／34）比25．1％（85／339），P=0．01；76．5％（26／34）比54．6％（185／339），P=0．04]。结论UC患者皮肤表现类型多样，以结节性红斑、坏疽性脓皮病为主。皮肤表现可以出现在UC诊断之前、之后或同时诊断，部分特殊类型皮肤表现的出现对UC诊断具有提示意义。UC患者的皮肤表现与UC活动度呈正相关，广泛结肠型UC患者更容易出现皮肤表现，尚需进一步研究证实。

Objective To investigate the cutaneous manifestations in patients with ulcerative colitis （UC） and related factors. Methods Patients admitted to Department of Gastroenterology Peking University First Hospital from January 1994 to December 2014 and diagnosed as UC were retrospectively enrolled in this study. Skin disorders were confirmed by the dermatologists. Clinical data were collected and compared between patients with and without cutaneous manifestations. Results Among the total 373 UC patients, there were 34 cases （9. 1% ） with cutaneous manifestations, including 11 pyoderma gangrenosum, 8 erythema nodosum, 6 eczema, 3 psoriasis, 2 pemphigus, 1 granulomatous cheilitis, 1 ichthyosis, 1 acne rosacea, and 1 impetigo. The skin manifestations may occur after the diagnosis, simultaneously or even before the diagnosis of UC, which were 24, 7 and 3 patients respectively. The mean age in patients with skin lesions was （47.2 ＋ 12.1 ） years, male to female ratio 0.79： 1. More patients with skin manifestations had severe activity of UC compared with non-skin group [50.0% （17/34） vs 25.1% （85/339）, P =0.01 ]. In addition, the proportion of extensive colitis in skin lesion group was significantly higher than that in non-skin group [ 76.5% （26/34） vs 54.6% （ 185/339）, P = 0.04 ]. Conclusions The cutaneous manifestations associated with UC are polymorphic, erythema nodosums and pyoderma gangrenosums are the most common skin lesions seen in UC patients. Skin lesions occur concurrently, pre or post the diagnosis of UC. Skin lesions in UC patients suggest more severe disease activity. Clinicians need to pay more attention to this group.