76例糖尿病性大疱病患者的临床特征及预后影响因素分析  

Clinical characteristics and factors influencing the prognosis of 76 cases of bullosis diabeticorum

作　　者：齐亚男 张执华 李彦[3] 张会峰 Qi Yanan;Zhang Zhihua;Li Yan;Zhang Huifeng(Department of Endocrinology,Zhengzhou University People′s Hospital,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Queen Mary College of Nanchang University,Nanchang 330006,China;Department of Dermatology,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院河南省人民医院内分泌科,450003 [2]南昌大学玛丽女王学院,330006 [3]河南省人民医院皮肤科,郑州450003

出　　处：《中华糖尿病杂志》2021年第3期233-237,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：河南省科技攻关项目 (172102310044)。

摘　　要：目的探讨糖尿病性大疱病(BD)的临床特点,并分析影响预后的因素。方法回顾性分析2016年10月至2020年9月河南省人民医院诊断明确的76例BD患者资料,分析其临床特点。根据治疗20 d患者的临床转归将患者分为预后良好组和预后不良组,对比两组患者临床资料的差异,包括性别、年龄、糖尿病病程、大疱部位及大小等,检测血红蛋白(Hb)、白蛋白(ALB)、糖化血红蛋白(HbA1c)等指标。采用χ^(2)检验比较两组患者的临床资料,再运用logistic回归模型分析影响预后的相关因素。结果 76例BD患者纳入研究,男67例、女9例,年龄(62.2±13.3)岁,糖尿病病程(11.2±7.2)年。所有患者发病前均无明显诱因,在正常皮肤上可见张力性大疱。大疱部位位于下肢68例、上肢8例,面积(14.9±11.7)cm2,63例(82.9%)大疱合并感染。治疗20 d,预后良好组42例,预后不良组34例。预后不良组的年龄≥60岁、大疱病史≥10 d、大疱面积≥20 cm2、大疱感染程度重、HbA1c≥9%、白细胞计数≥9.5×109/L、C反应蛋白≥10 mg/L、ALB<35 g/L、周围血管病变程度重的患者所占比例明显高于预后良好组,差异有统计学意义(P<0.05)。logistic回归分析结果显示,大疱面积大、大疱感染程度重、HbA1c高是预后不良的独立危险因素(P均<0.05)。结论 BD多发于糖尿病病程长、血糖控制不佳的老年男性糖尿病患者。大疱面积、继发感染、血糖控制不佳是影响预后的独立危险因素。Objective To investigate the clinical features of bullosis diabeticorum(BD),and to analyze the factors affecting the prognosis.Methods The clinical data of patients with BD(n=76)admitted to the Henan Provincial People′s Hospital were collected,and their clinical characteristics were summarized and analyzed.Patients were divided into two groups:good prognosis group and poor prognosis group according to the clinical outcomes after 20 days treatment period.The differences in clinical data between patients with different outcomes,including gender,age,duration of diabetes,location and size of bullae,hemoglobin(Hb),albumin(ALB),and glycated hemoglobin A1c(HbA1c)were detected.The Chi-square test was used to compare the clinical data between the two groups,and further logistic regression model was used to analyze the relevant factors affecting the prognosis.Results The male-to-female ratio of 76 BD patients was 67/9,with an average age of(62.2±13.3)years,the course of diabetes mellitus was(11.2±7.2)years.All patients had no obvious inducement before the occurrence of bullae,tension bullae appeared on normal skin,mostly in the lower limbs;the average area was(14.9±11.7)cm2,82.9%(63/76)of patients with bullae were coinfected at admission.The clinical data of patients in good prognosis group(n=42)and poor prognosis group(n=34)were compared,the proportion of age≥60 years old,duration of diabetes≥10 days,bullous area≥20 cm2,serious infections,HbA1c≥9%,white blood cell≥9.5×109/L,C-reactive protein≥10 mg/L,ALB<35 g/L and severe peripheral vascular disease in the group with poor prognosis were significantly higher than those in the group with good prognosis(P<0.05).Further logistic regression analysis showed that large bulla area,severe infection and poor glycemic control were independent risk factors for poor prognosis(all P<0.05).Conclusions BD occurs more often in elderly male diabetic patients with long diabetes duration and poor blood glucose control,and the bullae have large and variable size and shape.Bu

关 键 词：糖尿病 糖尿病性大疱病 糖尿病皮肤病变 预后 感染 

分 类 号：R587.2[医药卫生—内分泌]