【作者】 陶苏江；

【导师】 顾军； 温海；

【作者基本信息】 第二军医大学 ， 皮肤病与性病学， 2004， 博士

【摘要】 银屑病的病因及发病机制至今尚未清楚，通常认为与遗传及环境因素有密切的关系，近来新的学说认为可能是T细胞异常的免疫性疾病。本课题旨在通过对我院近十年来住院的388例银屑病患者及87例重症银屑病患者进行回顾性分析，来揭示银屑病的某些发病规律，进而提出较合理的预防及治疗方案。本课题对住院银屑病患者的病史、实验室检查及诊治情况列出五十多个指标进行整理分析，并进行统计学处理。我们发现银屑病患者的发病年龄高峰在20～40岁，平均发病年龄32岁，男女之间无显著差异，同以往的流行病学资料相符；在发病诱因方面上呼吸道感染成为银屑病诱发或加重而住院的突出因素。实验室检查未发现银屑病与内脏疾病有明确的关系，比例较高的肝功能异常或脂肪肝与银屑病本身无明确关系，而与年龄及维甲酸类药物的使用显著相关。寻常型银屑病的防治宜重在宣教，避免上感等诱因，治疗重点宜放在改善症状而非达到根治，系统应用中西医结合，外用温和制剂控制症状。在重症银屑病治疗的药物选择上，维甲酸类药常用于红皮病型、脓疱型，而关节病型可消除皮损，但对缓解关节症状不好；环孢菌素A属免疫抑制剂，对皮损较好。糖皮质激素多用于脓疱型、红皮病型，但要尽快撤药，而且在应用其它方法无效时才考虑使用。消炎镇痛类药物对关节病型银屑病为首选，但不主张用消炎痛，有报道可加重银屑病。雷公藤、氨甲喋呤对关节病型银屑病有较好的效果，但要加强对血常规、肝功能的检查。环磷酰胺亦可用，但不作为首选药。更多还原

【Abstract】 The pathogenesis of psoriasis is still unclear, however, it is recognized that psoriasis is closely associated with genetics and enviromental factors. This article is aimed to disclose some clues of the development of psoriasis and make a suggestion of more reasonable protocols of prevention and therapy by collecting and analyzing 388 patients’ history with psoriasis and 87 patients with severe psoriasis who were admitted in our hospital during last ten years. More over 50 parametes are designed to meet the demand, including past history, laboratory examination and therapy effects by different protocols. All available datas are dealt with by statistical analysis. It was demonstrated that the age of onset was 20 to 40 years old , the average age of onset was 32 years old, no difference between males and females, which is coincided with traditional epidemiology. Getting cold is becoming the primary exacerbating cause, which lead patients to hospital admission. Laboratory examination found no definite relationship between psoriasis and internal disorders. Patients with liver dysfuncion or fatty liver occupy a little higher ratio in our data, however, which have no correlation with psoriasis but with advancing age and retinoids taking. From our retrospective study, we draw a conclusion that the emphasis of prevention and treatment of psoriasis should be put on to educate patients and avoid getting cold . The goal of theapy is not to effect a radical cure but ameliorate this disorders. The combination between Traditional Chinese Medicine and Western Medicine and topical therapy with gentle agents are the first choice to improve the patients with psoriasis vulgaris. As for the drugs to control severe psoriasis, retinoids are usually prescribed to patients with psoriasis erythroderma or pustulosa. They can improve the skin lesion but can’t lessen joint pain on patients with psoriatic arthritis, which is the same as an immunosupuressant of cyclosporin A. Glucocorticosteroids can be sometimes used in treating patients with psoriasis erythroderma or psoriasis pustulosa, especailly those patients with no effects of other agents, and they should be withdrawn as soon as possible. NSAIDs are the firstchoice to treat patients with psoriatic arthritis, but indomethacin should not be choosed as it might aggravate the skin lesion. LeiGongTeng and methotrexate have an optimal effects to control joint symptoms of patients with psoriatic arthritis but should monitor the blood routine and hepatic function. Cyclophosphamide can also be administered but not the first choice.更多还原