摘要
目的探讨坏疽性脓皮病(PG)的临床特征及治疗方式。方法回顾性分析2013年5月至2021年5月就诊于广西壮族自治区人民医院皮肤科门诊及病房的35例PG患者的一般资料、诱因、皮疹分布、皮疹形态、误诊情况、并发症及治疗方式。结果男女患者比例为2.9∶1,年龄29~72(41.5±8.5)岁。15例患者起病前有明确诱因,外伤11例,昆虫叮咬3例,注射吸毒1例。35例患者中溃疡型32例(91.43%),大疱型2例(5.71%),脓疱型1例(2.86%)。起病初期最常被误诊的疾病为细菌性软组织感染[32例(91.43%)]。皮损通常为2个及以上。皮损多发于下肢[23例(65.71%)],以小腿为主。合并有系统性疾病8例(22.86%),其中合并炎症性肠病5例(14.29%),多发性关节炎2例(5.71%),白血病1例(2.86%)。无合并症或合并炎症性肠病、多发性关节炎的患者预后较好,合并血液系统疾病的患者预后差。33例PG患者基于皮损面积的大小及合并症情况,给予强的松0.5~1 mg/(kg·d)。在感染稍控制后,28例患者后续加用环孢素2.5~5 mg/(kg·d)。结论PG的临床表现多种多样,起病初期易误诊,需结合临床表现及治疗效果综合判定。中等至大剂量皮质类固醇激素可有效控制PG,激素联合环孢素治疗安全有效。
Objective To investigate the clinical characteristics and treatment methods of pyoderma gangrenosum(PG).Methods From May 2013 to May 2021,35 patients with pyoderma gangrenosum who were treated in the Outpatient Department and the Ward of the Department of Dermatology of the People′s Hospital of Guangxi Zhuang Autonomous Region were retrospectively analyzed for their general data,causes,rash distribution,rash morphology,misdiagnosis,complications and treatment methods.Results The ratio of male to female patients was 2.9∶1,and the age ranged from 29 to 72 years,with an average age of(41.5±8.5)years.Fifteen patients had definite predisposing factors,including trauma in 11 cases,insect bite in 3 cases and injection of drug abuse in 1 case.Among the 35 patients,there were 32 cases(91.43%)of ulcerative type,2 cases(5.71%)of bullous type,1 case(2.86%)of pustular type.At the initial stage of the disease,the most frequently misdiagnosed disease was bacterial soft tissue infection(32 cases,91.43%).Skin lesions are usually 2 or more.There were 23 cases(65.71%)of skin lesions in the lower limbs,mainly in the calves.Eight patients(22.86%)were found to have concurrent or subsequent systemic diseases,including 5 patients(14.29%)with inflammatory bowel disease,2 patients(5.71%)with multiple arthritis,and 1 patient(2.86%)with leukemia.The patients without complications or complicated with inflammatory bowel disease and polyarthritis had a better prognosis,while those with hematological diseases had a worse prognosis.The systemic treatment was based on the size of lesions and complications,and the dose of prednisone was 0.5-1 mg/(kg·d).After the infections were slightly controlled,28 patients were subsequently given cyclosporine 2.5~5 mg/(kg·d).Conclusion The clinical manifestations of PG are varied,and it is easy to be misdiagnosed at the initial stage of the disease,and a comprehensive judgment should be made according to clinical manifestations and treatment effects.Moderate to high dose corticosteroids can effectively control PG,and the combined corticosteroid therapy with cyclosporine is safe and effective.
作者
徐豫昕
谢治
李玉秋
王静
潘南楠
XU Yu-xin;XIE Zhi;LI Yu-qiu(Department of Dermatology,Guangxi Hospital Division of the First Affiliated Hospital,Sun Yat-sen University,Nanning 530022,China)
出处
《中国临床新医学》
2023年第8期838-841,共4页
CHINESE JOURNAL OF NEW CLINICAL MEDICINE
