高频超声辅助评估丹毒治疗效果的前瞻性对照研究

High-frequency ultrasonography-assisted evaluation of treatment outcomes of erysipelas:a prospective controlled study

目的采用高频超声观察丹毒患者皮肤厚度的变化以评估系统应用抗生素治疗的基础上短期联合糖皮质激素与单用抗生素治疗丹毒的临床疗效。方法 2021年1 - 12月于东南大学附属中大医院诊断为丹毒并住院治疗的患者, 按就诊顺序随机分为研究组和对照组。研究组系统应用头孢硫脒7 d后加口服甲泼尼龙片(0.4 mg·kg-1·d-1)治疗, 对照组仅接受头孢硫脒治疗。采用高频超声记录两组患者治疗前及治疗10 d后患侧病变最严重处及健侧对应部位表真皮厚度、皮下组织厚度, 治疗前后检测外周血白细胞(WBC)计数、中性粒细胞(NEU)计数、C反应蛋白(CRP)水平。采用t检验、非参数检验进行两组间疗效比较。结果纳入23例丹毒患者, 研究组12例, 男8例, 女4例, 年龄(71.4 ± 11.4)岁;对照组11例, 男7例, 女4例, 年龄(67.4 ± 11.1)岁。治疗前, 研究组患侧表真皮厚度[(0.33 ± 0.12) cm]、皮下组织厚度[(1.08 ± 0.49) cm]与对照组[(0.25 ± 0.09) cm、(0.98 ± 0.46) cm]比较差异均无统计学意义(t = 1.83、0.49, P = 0.081、0.626)。治疗10 d后, 两组患侧表真皮厚度、皮下组织厚度均较治疗前减少(均P < 0.05), 研究组皮下组织厚度下降程度[(0.32 ± 0.33) cm]显著高于对照组[(0.10 ± 0.07) cm, t = 2.20, P = 0.039]。治疗前, 研究组WBC计数、NEU计数、CRP水平与对照组比较差异均无统计学意义(t值或Z值分别为0.60、0.71、-0.85, 均P > 0.05)。治疗10 d后, 两组WBC、NEU、CRP水平均较治疗前显著下降(P < 0.05)。结论系统应用抗生素治疗的基础上短期联合糖皮质激素治疗丹毒能有效减轻皮肤炎症, 与单用抗生素相比可更快消除皮下组织水肿。

Objective To measure the skin thickness in patients with erysipelas by high-frequency ultrasonography(HF-USG),and to compare the clinical efficacy of systemic antibiotics alone versus their combination with glucocorticoids in the treatment of erysipelas.Methods Hospitalized patients with erysipelas were enrolled from Zhongda Hospital,Southeast University from January to December in 2021,and randomly divided into the study group and control group according to the order of visits.The study group was treated with systemic cefathiamidine for 7 days followed by oral methylprednisolone at a dose of 0.4 mg·kg^(-1)·d^(-1),while the control group was treated with cefathiamidine alone.Before and after the treatment for 10 days,the thickness of the epidermis-dermis layers and subcutaneous tissues was measured by HF-USG at the sites of the most severe skin lesions on the affected limbs and at the corresponding sites on the healthy limbs,and white blood cell(WBC)counts,neutrophil(NEU)counts,as well as C-reaction protein(CRP)levels were determined.The t test and non-parametric test were used to compare the efficacy between two groups.Results A total of 23 patients with erysipelas were enrolled.Among the 12 patients in the study group,8 were males and 4 were females,and their age was 71.4±11.4 years.Among the 11 patients in the control group,7 were males and 4 were females,and their age was 67.4±11.1 years.Before treatment,the thickness of the epidermis-dermis layers(0.33±0.12 cm)and subcutaneous tissues(1.08±0.49 cm)in the study group was not significantly different from that in the control group(0.25±0.09 cm,0.98±0.46 cm;t=-1.83,-0.49,P=0.081,0.626,respectively).After the 10-day treatment,the thickness of the epidermis-dermis layers and subcutaneous tissues of the skin lesions on the affected limbs significantly decreased in both groups compared with that before treatment(both P<0.05),and the decrease in the thickness of subcutaneous tissues was significantly stronger in the study group(0.32±0.33 cm)than in the control group(0.10±0.07 cm;t=2.20,P=0.039).Before treatment,the WBC counts([11.16±4.42]×10^(9)/L),NEU counts([8.26±4.16]×10^(9)/L)and CRP levels(median[Q1,Q3]:72.20[19.28,140.50]mg/L)in the study group were not significantly different from those in the control group([10.10±4.53]×10^(9)/L,[7.21±3.00]×10^(9)/L,34.40[8.00,74.20]mg/L,respectively;t or Z=0.60,0.71,-0.85,P=0.578,0.496,0.196,respectively).After the 10-day treatment,the WBC counts,NEU counts,and CRP levels significantly decreased in both groups compared with those before treatment(all P<0.05).Conclusion The combined treatment with systemic antibiotics and glucocorticoids could effectively alleviate skin inflammation,and more rapidly reduce the thickness of inflamed subcutaneous tissues in patients with erysipelas compared with systemic antibiotics alone.