玫瑰痤疮真实世界诊疗现状调查分析

Diagnosis and treatment of rosacea in the real world:a survey on the current status

目的分析我国玫瑰痤疮的诊疗现状,加强对疾病的认知和管理。方法采用回顾性横断面研究,纳入南北方6个省或直辖市23家三级医院的玫瑰痤疮患者,以问卷调查的方式收集患者的临床特征、既往诊断和治疗情况。非正态分布的连续变量以M(Q1,Q3)表示,比较采用Mann-Whitney U检验。分类变量比较采用χ2检验。结果593例玫瑰痤疮患者中,男164例,女429例,男女比例1∶2.6;来自南方205例,北方388例;20~40岁最常见(349例,58.8%),北方地区就诊患者的中位年龄(37岁)显著大于南方(30岁,P<0.001)。患者中常见多部位受累(371例,62.6%)和多种表型共存(391例,65.9%),面颊(429例,72.3%)和鼻部(393例,66.3%)最易受累,皮疹以持续性红斑(354例,59.7%)、丘疹脓疱(344例,58.0%)、毛细血管扩张(282例,47.6%)多见。南方患者(160例,78.0%)面颊部受累较北方患者(269例,69.3%)更多见,但鼻部(南方:125例,61.0%;北方:268例,69.1%)和眼部(南方:3例,1.5%;北方:23例,5.9%)受累少见(均P<0.05)。南方患者一过性红斑(38.0%)和丘疹脓疱发生率(65.4%)均较北方高(分别为20.9%和54.1%),而北方患者更多表现为持续性红斑(南方49.8%,北方64.9%;均P<0.05)。玫瑰痤疮患者病程M(Q_(1),Q_(3))为12(4,30)个月,从发病到诊断时间10(3,24)个月,北方患者病程[12(4,36)个月]及>5年患者比例(63例,16.4%)均高于南方[12(3,24)个月;19例,9.4%;均P<0.05]。不同亚型及严重程度的患者既往以外用抗微生物药物为主(使用率71.9%);轻症患者系统用药率达72.7%;患者依从性差,单次治疗4周以上者仅占40.6%。结论我国玫瑰痤疮好发于中青年,面颊及鼻部最易受累,以红斑或丘疹脓疱多见。在临床诊疗中存在诊断延迟、药物治疗不规范、患者依从性差等问题。

Objective To analyze the current status of diagnosis and treatment of rosacea in China,and to strengthen the understanding and management of this disease.Methods A retrospective cross-sectional study was conducted,and patients with rosacea were enrolled from 23 tertiary hospitals in 6 provinces or municipalities in northern and southern China.Clinical characteristics,previous diagnosis and treatment status of these patients were collected through questionnaires.Non-normally distributed continuous data were described by M(Q1,Q3),and compared using Mann-Whitney U test,while categorical data were compared using chi-square test.Results Among the 593 patients with rosacea,164 were males and 429 were females,with a male-to-female ratio of 1∶2.6;205 patients were from southern China,and 388 from northern China;most patients(349 cases,58.8%)were aged 20 to 40 years,and the patients from northern China were significantly older than those from southern China(median age:37 years vs.30 years,P<0.001).Multiple-site involvement(371 cases,62.6%)and coexistence of multiple phenotypes(391 cases,65.9%)were common,the cheeks(429 cases,72.3%)and nose(393 cases,66.3%)were mostly affected,and skin lesions mainly manifested as persistent erythema(354 cases,59.7%),papulopustules(344 cases,58.0%),and telangiectasia(282 cases,47.6%).Involvement of the cheeks was more common in the patients from southern China(160 cases,78.0%)than in those from northern China(269 cases,69.3%),but the nose and eyes were less involved in the patients from southern China than in those from northern China(nose:125 cases[61.0%]vs.268 cases[69.1%];eyes:3 cases[1.5%]vs.23 cases[5.9%];both P<0.05).The prevalence of transient erythema and papulopustules was significantly higher in the patients from southern China(38.0% and 65.4%,respectively)than in those from northern China(20.9% and 54.1%respectively,both P<0.05),while the patients from northern China more frequently presented with persistent erythema compared with those from southern China(64.9%vs.49.8%,P<0.05).The disease duration(M[Q_(1),Q_(3)])was 12(4,30)months among the patients with rosacea,and the time from the onset to diagnosis was 10(3,24)months.The disease duration was significantly longer(12[4,36]months),and the proportion of patients with disease duration>5 years was significantly higher(16.4%[63 cases])in the patients from northern China than in those from southern China(12[3,24]months,9.4%[19 cases],respectively;both P<0.05).The patients with varied subtypes and severity of rosacea were previously mainly treated with topical antimicrobial agents(71.9%);72.7% of the patients with mild rosacea were treated with systemic drugs;poor patient compliance was observed,and only 40.6% of the patients completed more than 4 consecutive weeks of treatment at a time.Conclusions Rosacea usually occurred in young and middle-aged people in China,mostly involved the cheeks and nose,and mainly manifested as erythema or papulopustules.Delayed diagnosis,non-standard treatment and poor patient compliance existed in clinical practice.