泛发性脓疱型银屑病82例临床分析

Clinical analysis of 82 cases of generalized pustular psoriasis

目的:分析泛发性脓疱型银屑病(generalized pustular psoriasis,GPP)的临床特征、实验室检查及治疗方法,揭示GPP的发病规律,评估其疗效转归。方法:回顾性分析中南大学湘雅二医院皮肤科82例(16例儿童,66例成人)GPP患者的临床资料。结果:82例GPP患者发病男女之比为1:1.1。无寻常型银屑病史GPP患者(GPP^(PSO–))发病年龄(25.5±21.2)岁,早于有寻常型银屑病史GPP患者(GPP^(PSO+))的(32.7±18.0)岁,GPP^(PSO–)住院时间为(12.1±6.7)d,长于GPP^(PSO+)的(11.6±10.2)d。从寻常型银屑病转型至GPP的时间为(77.8±71.9)个月。儿童组以感染(33.3%)和药物(33.3%)为主要诱发因素。成人组GPP^(PSO+)患者以药物诱发(75.0%)为主,而GPP^(PSO–)患者主要由感染因素(41.7%)诱发。阿维A治疗效果确切。结论:儿童组及成人组GPP临床特点不尽相同。阿维A可作为GPP的一线药物,同时适用于儿童及成人,慎用激素类药物。

Objective： To analyze clinical features, laboratory tests, treatment and prognosis for patients with generalized pustular psoriasis （GPP）. Methods： Clinical data of 82 patients with GPP （16 cases of children, 66 cases of adults） from the Department of Dermatology, Second Xiangya Hospital, Central South University were retrospectively analyzed. Results： Among the GPP patients, the male to female ratio was 1：1.1. Average age of onset in patients without history of psoriasis vulgaris （GPPPSO-） was earlier than that of patients with history of psoriasis vulgaris （GPPPSO＋） [ （25.5±21.2） years vs （32.7±18.0） years]. The average day of hospitalization in GPPPSO- group was longer than that in GPP PSO＋ group [ （12.1±6.7） days vs （11.6±10.2） days]. The transformation time from psoriasis vulgaris to GPP was （77.8±71.9）months. Infection （33.3%） and drugs （33.3%） were the main etiological factors in children with GPP. In adults with GPP, 75.0% ofGPPPSO＋patients were caused by infection, but 41.7% ofGPPPSO- patients were caused by drugs. Acitretin had favorable effect in the treatment of GPP. Conclusion： The clinical features of GPP in children and adults are different. Acitretin could be considered as a first-line therapy for GPP in children and adults, but corticosteroid should be used cautiously.