泛发性脓疱性银屑病138例临床分析

Clinical analysis of 138 cases with generalized pustular psoriasis

目的探讨泛发性脓疱性银屑病(GPP)的临床特征及发病规律。方法回顾性分析2015年1月一2020年10月在陆军军医大学第一附属医院皮肤科住院部收治的138例(203次住院)GPP患者的临床资料。结果有明确诱因者117例(57.64%),其中药物(54.70%)和感染(35.04%)为主要诱发因素。39.41%的患者有发热,发热程度与GPP病情严重程度密切相关。成人组出现低钾、低钙和高脂血症的几率大于儿童及青少年组。52.17%的GPP患者有寻常性银屑病(PV)病史,即GPP^(PSO+),由PV转化为GPP的平均时间约为8.5年。无PV病史的GPP患者(GPP^(PSO-))组出现中性粒细胞计数升高、降钙素原升高、贫血的几率大于GPP^(PSO+)组;GPP^(PSO+)组更容易出现高脂血症、高尿酸血症。低钙组更易出现白细胞升高、低钾、低蛋白血症、贫血等。结论药物和感染是临床上GPP主要的诱发因素成人组及GPP^(PSO+)组患者更容易合并高脂血症、高尿酸血症等代谢问题,GPP^(PSO-)组、低钙组患者病情可能更重。

Objective To investigate the clinical features and pathogenesis of generalized pustular psoriasis(GPP).Methods The clinical data of 203 episodes of 138 patients with GPP hospitalized in the dermatology department of Southwest Hospital from January 2015 to October 2020 were analyzed retrospectively.Results There were 117 cases(57.64%)with clear predisposing factors,of which drugs(54.70%)and infection(35.04%)were the main ones.39.41%of patients had fever,which was closely related to the severity of GPP.The probability of hypokalemia,hypocalciuric,and hyperlipidemia in adults was higher than that in children and adolescents.52.17%of GPP patients had a history of psoriasis vulgaris(GPP^(PSO+)),and the average time from PV to GPP was about 8.5 years.The incidence of increased neutrophils,increased procalitonin,and anemia in the GPP group without a history of psoriasis vulgaris(GPP^(PSO-))was higher than that in the GPP^(PSO+)group.The GPP^(PSO+) group was more prone to develop hyperlipidemia and hyperuricemia.The low calcium group was more likely to have elevated white blood cells,hypokalemia,hypoalbuminemia,anemia,and so on.Conclusion Drugs and infection were the main clinical predisposing factors of GPP.Adult group and GPP^(PSO+) group patients were more likely to have metabolie disorders such as hyperlipidemia and hyperuricemia,while GPP patients i the GPP^(PSO-) group and the low calcium group may have more severe disease progression.