33例脂膜炎与结核感染相关性分析

Analysis of association between panniculitis and tuberculosis infection in 33 cases

目的了解不同类型的脂膜炎患者与结核感染的相关性。方法纳入2019年1月—2021年12月就诊于常德市第一人民医院33例脂膜炎患者的临床资料,对其临床特征、病理特征、与结核感染的相关性、治疗情况及随访情况进行分析。结果①33例脂膜炎患者中,结节性红斑24例,硬红斑9例,男女比例为1∶4.5,平均年龄46岁,平均病程10个月。②临床发病部位集中在四肢,均伴有疼痛。30例(90.91%)表现为红斑、结节、肿胀,其中1例硬红斑(3.03%)出现溃疡。6例(18.18%)出现发热、咳嗽、盗汗。2例硬红斑患者同时伴有或先后出现丘疹性坏死性结核疹,2例结节性红斑患者伴有全身多关节疼痛。③22例(66.67%,包括9例硬红斑、13例结节性红斑)伴结核分支杆菌潜伏感染(LTBI)。硬红斑患者结核感染阳性率高于结节性红斑患者(P=0.020)。④皮损组织病理表现为间隔性脂膜炎11例、小叶性脂膜炎3例、混合性脂膜炎19例。与结核感染相关的22例脂膜炎患者病理下多可见上皮细胞肉芽肿、多核巨细胞以及干酪样坏死,其余11例均可见真皮层血管周围及脂肪间隔淋巴细胞浸润,且均未见上皮样肉芽肿及多核巨细胞。33例患者抗酸染色、PAS染色、直接免疫荧光均未见阳性表现。⑤22例与结核感染相关患者中,接受抗结核治疗15例,治愈率为68.18%,拒绝接受抗结核治疗患者7例,治愈率为14.29%。11例结核感染不相关患者采用免疫调节联合治疗,治愈率为100%。所有患者均未出现严重药物不良反应。结论硬红斑患者的结核感染阳性率比结节性红斑患者高。在结核感染相关的脂膜炎患者中,接受抗结核治疗者治愈率比免疫调节联合治疗者高;对于未发现结核感染证据的结节性红斑,免疫调节治疗可能有效。结节性红斑患者的发病原因可能与结核感染相关。在结核高发地区,结节性红斑患者完善相关筛查极其重要。

Objective To reveal the association between different types of panniculitis and tuberculosis infection.Methods The clinical data of 33 patients with panniculitis were collected from January 2019 to December 2021 and analyzed association of epidemiology,clinical features,and pathological features with tuberculosis infection,efficacy of anti-tuberculosis treatment,and adverse reactions in some patients,and follow-up after the treatment.Results①Among the 33 patients with panniculitis,24 cases were erythema nodosum and 9 cases were Bazin's disease.The male to female ratio was 1∶4.5.The average age was 46 years,and the average disease duration was 10 months.②The lesions with pain,erythema,nodules and swelling were observed in 90.91%of the patients,including a case of Bazin's disease with ulcer(3.03%).Fever,cough and night sweats were found in 18.18% of patients.Two cases with Bazin's disease had papulonecrotic tuberculid,and two patients with erythema nodosum had systemic multi-joint pain.③Twenty-two of 33(66.67%)patients with panniculitis were associated with tuberculosis infection.There were 9 cases of Bazin's disease and 13 cases of erythema nodosum with mycobacterium tuberculosis latent infection(LTBI).The positive rate of tuberculosis infection was significantly higher in patients with erythema induratum than in patients with erythema nodosum(P=0.020).④The pathological manifestations included septal panniculitis(11 cases),lobular panniculitis(3 cases)and mixed panniculitis(19 cases).Epithelial-cell granulomas,multinucleated giant cells,and caseous necrosis were seen in 22 patients associated with tuberculosis infection.Perivascular and fat septal lymphocytic infiltration in the dermis were observed in 11 patients unrelated to tuberculosis infection,with no epithelioid granuloma or multinucleated giant cells.All 33 patients showed negative for acid-fast staining,PAS staining and direct immunofluorescence.⑤Among the 22 cases related to tuberculosis infection,15 cases received anti-tuberculosis treatment,resulting in a cure rate of 68.18%,while the cure rate was 14.29% in 7 cases who declined anti-tuberculosis.Eleven patients unrelated tuberculosis infection were cured following the treatments with immunomodulatory combination therapy.No serious adverse drug reactions were observed.Conclusions The positive rate of tuberculosis infection in patients with Bazin's disease was significantly higher than that in patients with erythema nodosum.In patients with tuberculosis infection-related panniculitis,the cure rate of anti-tuberculosis therapy was significantly higher than that of immunomodulatory combination therapy.For erythema nodosum with no evidence of tuberculosis infection,immunoregulatory therapy may be effective.The etiology of erythema nodosum may be related to tuberculosis infection.