中国县域银屑病患者临床特征和就诊现状调查

Clinical characteristics of psoriasis and current status of medical care for patients in county areas of China

目的了解我国县域范围银屑病患者的临床特征和就诊现状。方法该研究为横断面调查。依托"千县无银"项目,于2023年2—6月,在率先开展项目的404个行政县459个县域医院皮肤科开展线上问卷调查,性别、民族、年龄、居住地、受教育情况、婚姻状况、皮肤病生活质量指数(DLQI)等由患者或监护人填写;银屑病病程、临床分型、银屑病共病、银屑病皮损面积和严重程度指数(PASI)、银屑病皮损体表面积(BSA)及既往治疗方式等由医生填写。结果共16935例患者完成问卷调查,年龄1~102(44.17±11.58)岁,30~59岁人群占比最高,共12026例(71.0%);男女性别构成比为2.21∶1;高中学历人群最多,为4117例(24.3%);有9940例(58.7%)患者曾经或现在有吸烟和/或饮酒的经历;病程为1~5年者最多,共7218例(42.8%)。DLQI≥10分者15630例(92.3%),PASI≥10分者8346例(49.7%),BSA≥10%者15017例(89.2%);临床分型中斑块型最多,为14965例(88.7%),其次为点滴型1141例(6.8%);最常见的初发部位为躯干,共12309例(72.9%)。共病中,报告最多的为高血压,共1681例(10.0%)。有7650例次报告了传统外用药物治疗效果,3112例次报告了系统药物治疗效果,分别有6269例次(81.9%)和2493例次(80.1%)报告疗效不好或完全没有疗效。结论县域银屑病就诊患者多为病程较短的重度患者,临床分型主要为斑块型,最常见的共病为高血压,大部分患者认为常规治疗效果不佳。

Objective:To investigate the clinical characteristics of psoriasis and status quo of medical care for patients in county areas of China.Methods:This study was a cross-sectional investigation.Based on the“Qianxian Wuyin”Project(a national project for upgrating ability for psoriasis care at county level),an online questionnaire survey was conducted in the dermatology departments of 459 county hospitals in 404 pilot administrative counties across China from February to June 2023.The questionnaire included demographic information of patients(gender,ethnicity,age,place of residence,education,marital status),and clinical characteristics of psoriasis(disease course),type,comorbidities,body surface area(BSA)and previous treatment.The Dermatology Life Quality Index(DLQI)and Psoriasis Area and Severity Index(PASI)were applied for assessing the quality of life and disease severity,and completed by patients or guardian and doctors,respectively.Results:A total of 16935 patients completed the questionnaire.The age of patients was 1-102(44.17±11.58)years,and 71.0%(12036/16935)were 30-59 years old.The ratio of male to female was 2.21∶1;24.3%(4117/16935)of patients had high school education;there were 9940 patients(58.7%)with previous or current smoking and/or alcohol use;42.8%(7218/16855)of patients had a disease course of 1-5 years.There were 15630 patients(92.3%)with DLQI≥10,8346 patients(49.7%)with PASI≥10,15017 patients(89.2%)with BSA≥10%.The plaque type was the most common disease type(n=14965,88.7%),and spotting type ranked the second(n=1141,6.8%).The most common initial site was the trunk(n=12309,72.9%).Among the comorbidities,hypertension was the most common one(n=1681,10.0%).There were 7650 reports of treatment response to conventional topical drug therapy and 3112 reports of treatment response to systemic drug therapy,with 6269(81.9%)and 2493(80.1%)reporting poor or no response,respectively.Conclusions:The survey shows that in the county areas of China,the majority of psoriasis patients are severe patients with short course of disease,plaque type is the most common type,and hypertension is the most common comorbidity;and the conventional treatment is less effective for most patients.