寻常性银屑病患者甲损害临床特征分析

Clinical features of nail involvement in patients with psoriasis vulgaris

目的：分析寻常性银屑病患者甲损害情况及其与银屑病临床表现、实验室指标及代谢综合征的关系。方法回顾性收集2011年9月1日至2014年4月1日就诊于北京协和医院皮肤科门诊的315例寻常性银屑病患者的临床资料，分析其甲损害情况和特点，甲损害发生与患者临床特征、实验室指标及代谢综合征的关系。结果315例寻常性银屑病患者中，156例（49.5%）有甲损害，其中甲凹点（57.7%）最常见，甲床角化过度（37.8%）、甲纵脊（34.0%）、甲剥离（28.2%）较为常见，而油甲（12.8%）及甲营养不良（3.8%）则相对较少。与无甲损害的患者相比，有甲损害的患者病程长（〉10年）且病情重（PASI〉10），差异有统计学意义（χ2=8.234、14.200，均P〈0.01），且有甲损害者PASI评分（中位数为9.10，P25、P75为3.88、18.38）明显高于无甲损害者[4.35（2.50，11.28）]（W=21350.50，P〈0.001）。有甲损害者头皮、上肢、躯干及下肢皮损面积大于无甲损害者（W=21744.0、23135.0、22743.5、22797.0，均P〈0.01），且甲损害与头皮皮损面积有相关性（Pearson列联系数rc c=0.224，P=0.01）。有甲损害者中代谢综合征的伴发比例（9.0%，13/145）与无甲损害者（6.5%，10/154）差异无统计学意义（χ2=0.643，P=0.423）。但银屑病甲损害与性别、银屑病家族史、发病早晚及实验室指标、代谢指标、BMI等无明显关联。结论寻常性银屑病甲损害常见，与病程长短、疾病严重程度有关。

Objective To investigate the prevalence and clinical features of nail involvement in patients with psoriasis vulgaris, and to explore its relationship with clinical manifestations, laboratory findings and metabolic syndrome. Methods Clinical data were collected from 315 outpatients with psoriasis vulgaris who visited the Department of Dermatology, Peking Union Medical College Hospital between September 1, 2011 and April 1, 2014, and retrospectively analyzed. The prevalence and clinical features of nail involvement in patients with psoriasis vulgaris, as well as its relationship with clinical manifestations, laboratory findings and metabolic syndrome were assessed. Results Of 315 patients with psoriasis vulgaris, 156（49.5%）had nail involvement. The most common nail abnormality was pitted nails （57.7%, 90/156）. Moreover, subungual hyperkeratosis （37.8%, 59/156）, longitudinal ridges（34.0%, 53/156）and onycholysis（28.2%, 44/156）were also common, while oil-drop patches（12.8%, 20/156） and onychodystrophy （3.8%, 6/156） were relatively uncommon. Compared with patients without nail involvement, those with nail involvement showed longer disease duration（〉10 years）and more severe conditions（psoriasis area and severity index[PASI]〉10）（χ2=8.234, 14.200, respectively, both P〈0.01）. PASI scores were also significantly higher in patients with nail involvement than in those without（M[P25 , P75]：9.10[3.88, 18.38]vs. 4.35[2.50, 11.28], W=21 350.50, P〈0.001）. In addition, patients with nail involvement showed significantly larger areas of psoriatic lesions in the scalp, upper limbs, trunk and lower limbs than those without nail involvement（W=21 744.0, 23 135.0, 22 743.5, 22 797.0, all P 〈 0.01）, and nail involvement was significantly associated with lesional areas in the scalp （rc c=0.224, P=0.01）. There was no significant difference in the prevalence of metabolic syndrome between patients with and without nail involvement（9.0%[13/145]vs. 6.5%[10/154],χ2=0.643, P=0.423）. However, there was no evidence for the association of nail involvement with gender, family history, the age at onset, metabolic indices, body mass index（BMI）of, or laboratory findings from, patients with psoriasis. Conclusion Nail involvement is common in patients with psoriasis vulgaris, and is closely associated with clinical course and severity of psoriasis.