特应性皮炎临床特征及诊断标准评估:基于2000-2020年165例住院患者的回顾性分析

Clinical features of atopic dermatitis and evaluation of its diagnostic criteria:a retrospective analysis of 165 inpatients with atopic dermatitis from 2000 to 2020

目的分析和总结特应性皮炎(AD)患者临床特点, 探讨Williams、日本和中国AD诊断标准的满足情况及差异。方法回顾性分析陆军军医大学西南医院2000年10月至2020年5月期间根据Williams标准或中国张氏标准确诊的165例特应性皮炎住院患者病历资料。采用Williams、日本和中国AD诊断标准重新评估, 比较不同标准之间的差异。计量资料组间比较采用t检验、方差分析或秩和检验;计数资料组间比较采用卡方检验或Fisher确切概率检验。结果 165例AD患者中, 66例(40.00%)2岁之前发病;95例(57.58%)伴有个人和/或家族特应性疾病史, 其中75例伴有个人特应性疾病史, 最常见的是过敏性鼻炎(28.48%)、哮喘(20.00%), 50例伴有家族特应性疾病史, 30例同时伴有个人和家族特应性疾病史。98例(59.39%)对尘螨过敏, 其中Ⅵ级过敏48例。外源性AD 130例(78.79%), 内源性AD 35例(21.21%), 两组发病年龄、嗜酸性粒细胞计数差异均有统计学意义(均P < 0.001)。满足Williams标准142例(86.06%), 不满足者23例, 两组之间发病年龄差异有统计学意义(P = 0.007);满足中国张氏标准150例(90.91%), 不满足者15例, 两组之间嗜酸性粒细胞计数差异有统计学意义(P = 0.001);满足中国姚氏标准160例(96.97%);全部满足日本标准。满足Williams标准、日本标准、张氏标准和姚氏标准的患者之间发病年龄、嗜酸性粒细胞计数、总IgE水平差异均无统计学意义(P > 0.05)。结论早期发病的AD更易合并最高级别的尘螨过敏;外源性AD较内源性AD患者发病年龄更低, 嗜酸性粒细胞计数更高;满足Williams标准的患者较不满足的患者发病年龄更低, 满足中国张氏标准的患者较不满足的患者嗜酸性粒细胞计数更高。

Objective To analyze and summarize clinical characteristics of atopic dermatitis(AD),and to discuss differences and consistency among the Williams',Japanese and Chinese diagnostic criteria for AD.Methods A retrospective analysis was performed on 165 hospitalized patients with AD diagnosed according to the Williams'criteria or the Chinese Zhang's criteria in Southwest Hospital of Army Medical University from October 2000 to May 2020.Clinical data were re-evaluated according to the Williams',Japanese and Chinese diagnostic criteria,and differences were analyzed among these criteria.Measurement data were compared by using t test,analysis of variance or rank sum test,and enumeration data were compared by using chi-square test or Fisher's exact test.Results Among the 165 patients,66(40.00%)developed AD before the age of 2 years;95(57.58%)had a personal and/or family history of atopic diseases,of whom 75 had a personal history of atopic diseases(mainly including allergic rhinitis[28.48%]and asthma[20.00%]),50 had a family history of atopic diseases,and 30 had both a personal and a family history of atopic diseases.A total of 98 patients(59.39%)were allergic to dust mites,including 48 with grade Ⅵ allergy.According to the total IgE level,130(78.79%)patients were diagnosed with exogenous AD,and 35(21.21%)with endogenous AD.There were significant differences in the age at onset and blood eosinophil count between the patients with exogenous AD and those with endogenous AD(both P<0.001).After re-evaluation,142(86.06%)patients met the Williams'criteria,23 did not,and there was a significant difference in the age at onset between the two groups of patients(P=0.007);150(90.91%)patients met the Chinese Zhang's criteria,15 did not,and there was a significant difference in blood eosinophil counts between the two groups of patients(P=0.001);160(96.97%)patients met the Chinese Yao's criteria;all patients met the Japanese criteria.There were no significant differences in the age at onset,total IgE level or blood eosinophil counts among patients meeting the Williams'criteria,meeting the Japanese criteria,meeting the Zhang's criteria,and those meeting the Yao's criteria(all P>0.05).Conclusion Patients with early-onset AD were prone to develop the highest-grade dust mite allergy;patients with exogenous AD were characterized by lower age at onset and higher eosinophil counts compared with those with endogenous AD;patients who met the Williams'criteria showed lower age at onset than those who did not,while patients who met the Chinese Zhang's criteria showed higher eosinophil counts than those who did not.