体内金属植入物与后天性掌跖角化症关联的初步研究  

A preliminary study on the relationship between in vivo metal implants and acquired palmoplantar keratodermas

作　　者：谢小鸳 刘芳 陈欢 许洁 孔庆涛 桑红 Xie Xiaoyuan;Liu Fang;Chen Huan;Xu Jie;Kong Qingtao;Sang Hong(Department of Dermatology,General Hospital of Eastern Theater Command,The First School of Clinical Medicine,Southern Medical University,Nanjing 210002,China)

机构地区：[1]南方医科大学第一临床医学院,东部战区总医院皮肤科,南京210002

出　　处：《中华皮肤科杂志》2022年第10期869-873,共5页Chinese Journal of Dermatology

基　　金：南京市重点专科(匹配SZDZK2016011)。

摘　　要：目的分析后天性掌跖角化症(PPK)患者的临床特征及金属植入物(MI)对患者血浆细胞因子的影响。方法本研究为观察性研究,收集2020年6月至2021年12月东部战区总医院皮肤科就诊的后天性PPK,以同期健康体检者为对照。PPK面积及严重度指数评分参考湿疹面积及严重度指数评分法,采用金属成分斑贴试验(MPT)检测两组金属过敏原,采用酶联免疫吸附试验检测血浆肿瘤坏死因子(TNF)α、干扰素(IFN)γ、白细胞介素(IL)4、IL-13、IL-17A、IL-8水平。非正态分布的计量资料以M(Q1,Q3)表示,采用秩和检验;计数资料组间比较采用χ^(2)检验。结果PPK患者组81例,男42例,女39例,平均年龄48岁(范围21~65岁),37例(45.7%)有MI,其中牙科植入物34例,骨科植入物2例,心内科植入物1例。对照组纳入36例健康体检者,两组年龄及性别构成差异无统计学意义(P>0.05)。MI组(37例)PPK面积及严重度指数评分[0.40(0.27,0.75)分]与无MI组(44例)[0.38(0.19,0.70)分]差异无统计学意义(Z=1.21,P=0.225)。PPK患者组46例、对照组30例行MPT检查,患者组金属阳性比例(14/46)高于对照组(2/30,χ^(2)=6.17,P=0.013);46例行MPT检查患者中,有MI患者金属阳性比例(10/25)高于无MI患者(4/21,校正后P<0.017)。患者组及对照组均有36例行血浆细胞因子检测,患者组血浆TNF-α[66.2(58.7,69.3)pg/ml]、IFN-γ水平[645.0(571.5,681.1)]均低于对照组[71.5(64.5,73.9)、716.5(620.4,785.0)pg/ml,P<0.05],两组间血浆IL-4、IL-13、IL-17A、IL-8水平差异均无统计学意义(P>0.05)。结论后天性PPK患者特别是有MI的患者MPT阳性更多见,金属与后天性PPK间存在一定的相关性,血浆TNF-α和IFN-γ水平改变可能与部分后天性PPK有关。Objective To investigate clinical characteristics of acquired palmoplantar keratodermas(PPK)and the effect of metal implants(MIs)on plasma cytokines in patients with PPK.Methods An observational study was conducted.Patients with acquired PPK were collected from Department of Dermatology,General Hospital of Eastern Theater Command from June 2020 to December 2021,and health checkup examinees during the same period served as controls.The PPK area and severity index was evaluated according to the eczema area and severity index,metal allergens were detected by metal patch test(MPT),and plasma levels of cytokines,including tumor necrosis factor(TNF)-α,interferon(IFN)-γ,interleukin(IL)-4,IL-13,IL-17A and IL-8,were detected by enzyme-linked immunosorbent assay.Non-normally distributed measurement data were expressed as median(quartile 1,quartile 3),and analyzed by rank sum test;intergroup comparisons of enumeration data were performed by chi-square test.Results A total of 81 PPK patients were collected,including 42 males and 39 females,and their average age was 48 years(range,21-65 years).In vivo MIs were found in 37(45.7%)patients,including dental implants in 34,orthopedic implants in 2,and cardiac implants in 1.During the same period,36 healthy subjects were included in the control group,and there was no significant difference in the age and gender composition between the two groups(P>0.05).No significant difference was observed in the PPK area and severity index between the MI group(37 cases,0.40[0.27,0.75]points)and non-MI group(44 cases,0.38[0.19,0.70]points;Z=1.21,P=0.225).Forty-six patients in the PPK patient group and 30 in the control group were subjected to MPT,and the positive rate of MPT was significantly higher in the patient group(14/46)than in the control group(2/30,χ^(2)=6.17,P=0.013),and was significantly higher in the patients with in vivo MIs(10/25)than in the patients without(4/21,adjusted P<0.017).Plasma cytokines were detected in 36 cases in the patient group and 36 in the control group.The plasm

关 键 词：皮肤角化病 掌跖 细胞因子类 肿瘤坏死因子α 干扰素γ 金属植入物 金属成分斑贴试验 

分 类 号：R758.5[医药卫生—皮肤病学与性病学]