女性青春期后痤疮临床分型与风险因素相关性研究

Relationship between clinical types and related risk factors in female patients with post-adolescent acne

目的 探讨女性青春期后痤疮不同临床分型与相关风险因素之间的关联。方法 对2016年1 - 10月期间在我院皮肤科门诊就诊的25岁以上女性青春期后痤疮患者，通过问卷的方式调查相关风险因素，由皮肤科医生进行患者皮损评估、临床分型分级。采用SPSS21.0软件进行统计学处理。组间均数比较采用t检验，计数资料比较采用卡方检验。结果 312例女性青春期后痤疮患者参与调查，其中轻中度痤疮268例（85.9%），重度44例（14.1%）；持续型241例（77.2%），迟发型71例（22.8%）；粉刺型102例（32.7%），丘疹型210例（67.3%）。相关风险因素调查发现，121例有季节加重因素，其中夏季加重者最多，有59例占18.9%；饮食加重因素中，辛辣刺激食物131例（42%），甜食93例（29.8%），油炸食物85例（27.2%）；196例（62.8%）有经前期加重现象；心理因素加重者161例（51.6%）；外源性化学物质接触加重者136例（43.6%）。丘疹型患者饮食、月经前加重及便秘因素较粉刺型具有更高风险（χ2值分别为4.523、4.068、3.910，均P 〈 0.05）；而粉刺型较丘疹型以及迟发型较持续型患者与外源性化学物质接触如化妆品的使用、暴露于污染的空气中、职业相关有害物质接触等更加相关（χ2值分别为6.579、9.057，均P 〈 0.05）。此外，与迟发型相比，经前加重现象在持续型中更为显著（χ2 = 4.512，P 〈 0.05）。结论 女性青春期后痤疮发病风险因素复杂，月经前加重现象在丘疹型和持续型青春期后痤疮中较为明显，饮食、便秘在丘疹型中具有更高风险，但粉刺型及迟发型还应考虑外源性化学物质接触情况。在临床诊疗女性青春期后痤疮中应考虑其分型。

Objective To investigate the relationship between clinical types and related risk factors in female patients with postadolescent acne. Methods Female outpatients with postadolescent acne aged more than 25 years were enrolled from Department of Dermatology of Renji Hospital between January and October 2016. A questionnaire survey was conducted to investigate related risk factors for postadolescent acne in the females. Skin lesions and clinical types were evaluated by dermatologists. Statistical analysis was carried out by t test for comparison of means between two groups and by chisquare test for comparison of ratios. Results A total of 312 female patients with postadolescent acne completed the survey, including 268 （85.9%） with mild to moderate acne and 44 （14.1%） with severe acne, 241 （77.2%） with persistent acne and 71 （22.8%） with lateonset acne, or 102 （32.7%） with comedonal postadolescent acne （CPAA） and 210 （67.3%） with papular postadolescent acne （PPAA）. Survey on related risk factors showed that 121 patients reported seasonal factors and 59 （18.9%） patients became worse in summer, and spicy, sweet and fried foods can aggravate the condition in 131 （42%）, 93 （29.8%） and 85 （27.2%） patients respectively. Other risk factors such as premenstrual period （62.8%, 196/312）, psychological factors （51.6%, 161/312） and exogenous chemical exposures （43.6%, 136/312） were complained of by the patients. Furthermore, premenstrual period, diet and constipation were found to be more associated with PPAA compared with CPAA （χ2 = 4.523, 4.068, 3.910, respectively, all P 〈 0.05）. Exogenous chemical exposures, such as the use of cosmetics, exposure to polluted air environment and occupational hazards, were more associated with CPAA compared with PPAA, as well as with lateonset acne compared with persistent acne （χ2 = 6.579, 9.057, both P 〈 0.05）. In addition, premenstrual exacerbation occurred more frequently in patients with persistent acne compared with those with lateonset acne （χ2 = 4.512, P 〈 0.05）. Conclusions The risk factors for the occurrence of female postadolescent acne are very complex. Premenstrual exacerbation plays a major role in the aggravation of papular and persistent postadolescent acne, diet and constipation are more associated with PPAA, and exogenous chemical exposures are still be considered in the aggravation of comedonal and lateonset postadolescent acne. Thus, clinical types should be considered in the diagnosis and treatment of postadolescent acne in females.