银屑病患者甲损害的临床特征与严重程度及相关因素调查

Studies of Clinical Characteristics,Severity and Related Factors of Fingernail Psoriasis

目的分析银屑病甲损害的临床特征及银屑病甲损害的严重程度评分(m NAPSI评分)与各因素的相关性。方法选择本院2016年10月-2017年3月接诊的90例银屑病患者,根据是否合并指甲损害分为病例组和对照组,将两组进行对比。结果 90例患者中,合并甲损害有49例(54.44%),其中,8例关节型银屑病患者出现甲损害,与寻常性银屑病患者相比差异有统计学意义(P<0.05)。合并甲损害的寻常性银屑病患者的PASI评分[7.9(2.6,12.3)]较无甲损害的寻常性银屑病的PASI评分[4(1.6,7.2)]更高(P<0.05)。有甲损害的银屑病患者皮损更易累及面部、头皮(P<0.05)。两组患者在性别、病程、舌的表现、有无在3个月内接受系统治疗、是否合并代谢性疾病、家族史等方面均无相关性(P>0.05)。病例组中共出现11种不同的甲损害表现,其中甲凹点31例(63.27%),其余包括甲分离、甲下角化过度、甲纵嵴、油滴甲、裂片状出血、近端甲板碎裂、甲横纹、白甲、甲皱襞受累、甲营养不良。甲评分较低组与较高组比较,m NAPSI评分与PASI评分呈正相关(P<0.05)。结论银屑病患者较常伴随甲损害,关节型银屑病患者合并甲损害的概率更高,甲凹点为最常见的甲损害,甲损害的严重程度与疾病严重程度相关。

Objective To analyze the clinical features of nail psoriasis, the relationship between the severity of nail psoriasis （ mNAPSI score） and associated factors. Methods Clin- ical data were collected from 90 outpatients with psoriasis who visited the department of dermatology, Beijing Hospital between October 1, 2016 and March 31, 2017. Pa- tients with fingernail psoriasis were in the case group, others were in the control group. Clinical features between the two groups were assessed. Results Of 90 pa- tients with psoriasis, nail involvement was found in 49 cases （54.44%） , 8 of whom were with psoriatic arthritis, and the difference was statistically significant （P 〈 0. 05 ） compared with psoriasis vulgaris. The PASI score [ 7.9 （2.6,12. 3 ） ] of the patients with nail involvement was higher than that of psoriasis vulglaris without nail damages [4（1.6,7.2） ], and the difference was statistically significant（P 〈0. 05）. The face and the scalp were more likely to be involved in patients with nail psoriasis （P 〈 0. 05, vs. patients without nail damage）. However, there was no significant differences in gender, course of disease, tongue manifestations, history of systematic therapy within 3 months, the combination of metabolic diseases and family history be- tween the two groups（P 〉0.05 ）. There were a total ll clinical manifestations of nail psoriasis, including the highest rate of nail pitting （31 cases, 63.27% ） and others such as onycholysis, subungual hyperkeratosis, longitudinal ridge, oil spot, splinter hemorrhages, nail plate crumbling, Beau＇s line, leukonychia, nail fold affected, on- ychodystrophy. A comparison between the two levels of mNAPSI scores revealed that mNAPSI scores were positively correlated with PASI scores, the difference was statis- tically significant （P 〈 0.05 ）. Conclusion Nail involvement is common in patients with psoriasis. Psoriatic arthritis is more likely to have nail involvement. The most common nail abnormality is pitting, and the severity of nail psoriasis is positively re- lated with the severity of psoriasis.