物理性荨麻疹临床特征:基于多中心医院问卷的横断面调查

Clinical features of physical urticaria: a multicenter hospital-based cross-sectional questionnaire survey in China

目的探讨我国物理性荨麻疹(PU)患者的临床特征和治疗现状。方法纳入12家三级医院皮肤科2019年1-12月诊断为PU的患者,在就诊时由医生填写调查问卷收集信息。调查内容包括基本人口学特征及皮疹瘙痒程度、风团数目、伴发症状(如皮疹疼痛、关节痛、发热)、亚型诊断及治疗方案等。采用单因素方差分析、Kruskal-Wallis检验和χ2检验分析各亚型组间指标差异。结果纳入PU患者612例,男268例,女344例,年龄(37.4±16.4)岁,初次发病年龄(35.1±16.4)岁,病程[M(Q1,Q3),0.50(0.25,2.00)]年;包括皮肤划痕症(SD)500例、热接触性荨麻疹(HCU)54例、冷接触性荨麻疹(CCU)43例、延迟压力性荨麻疹(DPU)15例。4种亚型间性别分布、年龄、初发年龄、病程差异无统计学意义(均P>0.05),关节痛患者比例、合并湿疹/皮炎患者比例、血清总IgE升高患者比例差异均有统计学意义(均P<0.05),其中DPU组患者的关节痛比例(4/15,26.7%)高于SD组(64/500,12.8%)、HCU组(1/54,1.9%)、CCU组(5/43,11.6%)(均P<0.05),HCU组患者合并湿疹/皮炎比例(2/54,3.7%)显著低于SD组(96/500,19.2%)、CCU组(7/43,16.3%)、DPU组(3/15,20.0%)(均P<0.05),SD组患者血清总IgE升高比例(185/500,37.0%)高于HCU组(9/54,16.7%)、CCU组(11/43,25.6%)、DPU组(4/15,26.7%)(均P<0.05)。307例(50.3%)PU患者选择忌口饮食,仅95例(15.5%)认为饮食治疗有效。初诊时予271例(44.3%)单独处方1种第二代H1抗组胺药(sgAH),258例(42.2%)联合处方2种及以上sgAH,17例(2.7%)处方加倍剂量。结论PU患者以中青年为主,女性高发,各亚型临床特征有差异。

Objective To investigate clinical features and current treatment status of patients with physical urticaria(PU)in China.Methods A questionnaire survey was carried out in patients diagnosed with PU at the first visit at the Department of Dermatology of 12 tertiary hospitals in China from January to December 2019.Physicians filled out the survey questionnaires,which included demographic characteristics,pruritus intensity,the number of wheals,concomitant symptoms(such as pain in skin rashes,arthralgia,and fever),subtypes of PU,treatment regimens,etc.Differences between groups were analyzed using one-way analysis of variance,Kruskal-Wallis test or chi-square test.Results Overall,612 PU outpatients were enrolled,including 268 males and 344 females;they were aged 37.4±16.4 years,their age at the onset was 35.1±16.4 years,and the disease duration(M[Q1,Q3])was 0.50(0.25,2.00)years.Of these patients,500 were diagnosed with symptomatic dermographism(SD),54 with heat contact urticaria(HCU),43 with cold contact urticaria(CCU),and 15 with delayed pressure urticaria(DPU).There were no significant differences in the gender distribution,age,age at onset,or disease duration among the 4 subtypes of PU patients(all P>0.05),but the proportions of patients with arthralgia,with eczema/dermatitis,and with elevated total serum IgE levels significantly differed among the 4 subtypes(all P<0.05).Concretely,the proportion of patients with arthralgia was significantly higher in the DPU group(4/15,26.7%)than in the SD group(64/500,12.8%),HCU group(1/54,1.9%),and CCU group(5/43,11.6%)(all P<0.05);the proportion of patients with eczema/dermatitis was significantly lower in the HCU group(2/54,3.7%)than in the SD group(96/500,19.2%),CCU group(7/43,16.3%),and DPU group(3/15,20.0%)(all P<0.05);the proportion of patients with elevated total serum IgE levels was significantly higher in the SD group(185/500,37.0%)than in the HCU group(9/54,16.7%),CCU group(11/43,25.6%),and DPU group(4/15,26.7%)(all P<0.05).Among the PU patients,307(50.3%)chose dietary avoidance,and only 95(15.5%)considered that the dietary avoidance was effective for the treatment of PU.At the initial visit,a single second-generation H1 antihistamine(sgAH)was prescribed in 271 cases(44.3%),two or more sgAHs in combination were prescribed in 258 cases(42.2%),and sgAHs were administered at double doses in 17 cases(2.7%).Conclusion The PU patients were predominantly young and middle-aged adults,and PU frequently occurred in females;the clinical characteristics varied among the subtypes of PU.