皮肤镜在银屑病患者疗效与用药不良反应评价中的应用价值

Application Value of Dermatoscope in Evaluation of Curative Effect and Adverse Drug Reaction of Patients with Psoriasis

目的探讨皮肤镜在银屑病患者疗效与用药不良反应评价中的应用价值。方法选择2022年1—5月在首都医科大学大兴教学医院皮肤科就诊的80例寻常型银屑病患者为研究对象,患者均接受一线外用药物治疗。在治疗前、治疗2个月后,对患者分别进行银屑病面积和严重程度指数(PASI)评分、皮肤镜评分,用两种评分方法分别对患者的疗效进行评价;治疗2个月后,分别用肉眼和皮肤镜观测皮损及周围皮肤有无外用药引起的皮肤不良反应。结果治疗前、治疗2个月后,PASI评分分别为(16.90±4.31)分、(7.07±1.32)分,皮肤镜评分分别为(5.45±1.38)分、(2.15±0.41)分,治疗前、治疗后PASI评分与皮肤镜评分均呈明显正相关(r=0.863,P=0.002;r=0.879,P=0.004)。PASI评分评价患者的治疗有效率为61.3%(49/80),皮肤镜评分为62.5%(50/80),Kappa一致性检验提示两种方法对银屑病患者疗效评价具有明显的一致性(Kappa=0.709,P<0.001)。以PASI评价为评估银屑病疗效的金标准,皮肤镜评价疗效的灵敏度为89.8%,特异度为80.6%,阳性预测值88.0%,阴性预测值83.3%,准确度86.2%,约登指数0.704。治疗2个月后,皮肤镜检测局部皮肤不良反应发生率高于肉眼观察[20.0%(16/80)比8.8%(7/80)](χ2=4.113,P=0.043)。结论皮肤镜在银屑病患者疗效与用药不良反应评价中具有良好的应用价值,其检测准确性较高,且操作便捷,有助于临床医师及时指导患者用药。

Objective To study the application value of dermatoscope in the evaluation of curative effect and adverse drug reaction of psoriasis patients.Methods A total of 80 patients with psoriasis vulgaris who went to the Department of Dermatology,Daxing Teaching Hospital of Capital Medical University from Jan.to May 2022 were included in the study.All the patients received first-line external drug treatment.Before treatment and 2 months after treatment,the patients were scored with psoriasis area and severity index(PASI)and dermatoscope respectively to evaluate the therapeutic effect.After 2 months of treatment,the skin lesions and surrounding skin were observed with naked eyes and dermoscope to see if there were adverse skin reactions caused by external drugs.Results Before and after 2 months of treatment,the PASI score was(16.90±4.31)and(7.07±1.32),and the dermoscopy score was(5.45±1.38)and(2.15±0.41),respectively.PASI score was significantly positively correlated with dermoscopy score before and after treatment(r=0.863,P=0.002;r=0.879,P=0.004).The response rate of the patients evaluated by PASI score was 61.3%(49/80),and that by dermoscopy score was 62.5%(50/80).Kappa consistency test showed that the two methods had significant consistency in the evaluation of the efficacy of psoriasis patients(Kappa=0.709,P<0.001).With PASI evaluation as the gold standard for evaluating the efficacy of psoriasis,the sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Youden index of dermatoscopic evaluation of efficacy were 89.8%,80.6%,88.0%,83.3%,86.2%and 0.704 respectively.After 2 months of treatment,the incidence of local adverse reactions detected by dermoscopy was higher than that observed by naked eye[20.0%(16/80)vs 8.8%(7/80)](χ2=4.113,P=0.043).Conclusion Dermatoscope has a good application value in the evaluation of the efficacy and adverse drug reactions of psoriasis patients,which is featured with high accuracy,convenient operation and is helpful to the clinicians for timely medication guidance to the patients.