麻风性葡萄膜病的调查研究

目的：了解麻风性葡萄膜病的特点和患病情况。方法：选择江苏泰兴市存活的麻风治愈者及现症患者1045例，由培训的眼科医生检查，资料输入计算机统计分析。结果：麻风杆菌的直接损害、Ⅱ型麻风反应和继发性角膜病引起的葡萄膜病占7．85％，现症(25％)、多菌型(24．47％)和病期长(38．93％)的病人患病率明显增高。损害以肉芽肿虹膜睫状体炎为特征，睫状充血占14．73％，瞳孔形状不规则(48．06％)、光反应消失(45．74％)、虹膜后粘连(35．66％)和小瞳孔(28．68％)比较常见，其次为瞳孔闭锁(19．38％)、虹膜前粘连(17．83％)、虹膜萎缩(17．05％)、色素脱落(15．5％)和膜闭(14．73％)o慢性虹膜睫状体炎并发白内障占81．54％，视力减退占60％，眼盲为40．24％，可治盲为52．73％。结论：麻风性葡萄膜病可因麻风杆菌直接侵犯，也可由Ⅱ型麻风反应引起。好发于现症、多菌型及病期长的病人。损害以肉芽肿虹膜睫状体炎为特征，多数并发白内障并导致视力损害。     

228例麻风的角膜病

江苏泰兴市１０４５例麻风患者中２２８例（２１．８２％）有角膜病，单眼的１３０例，双眼９８例，多为角膜感觉丧失（６５．３５％）和角膜炎（５９．２１％），其次为角膜的感觉减退（３４．６５％）、云翳（２５％）和白斑（１９．３％）。导致角膜损害的主要因素有三叉神经受侵、眼睑闭合不全及睑外翻。因角膜溃疡、角膜白斑和角膜疤痕导致视力损害的占４１．７６％，其中眼盲占２５．４４％；只有４８％的视力损害者是可治的。麻风的型别、病程及反应和治疗是否规则，与角膜损害亦有明显的关联。防治麻风角膜病应列为防盲的重点之一     

228例麻风的角膜病

江苏泰兴市１０４５例麻风患者中２２８例（２１．８２％）有角膜病，单眼的１３０例，双眼９８例，我为角膜感觉丧失（６５．３５％）和角膜炎（５９．２１％），其次为角膜的感觉减退（３４．６５％）云翳（２５％）和白斑（１９．３％），导致角膜损害的主要因素有三叉神经受侵、眼睑闭合不全及睑外翻、因角膜溃疡、角膜白斑和角膜疤痕导致视力的占４１．７６％，其中眼盲占２５．４４％；只有４８％的视力损害者中可治的，麻风的     

广东省1692例麻风病人的眼病调查

作者对广东17个县麻风院中的1692例现症和治愈病人进行了10个方面75项眼科检查,发现眼病患病率为90.9％,患者平均53岁,多为老残患者,无性别差异,但致盲和低视力者却女明显多于男,可能与女性寿命长有关;治愈者多于现症病人;麻风病程愈长,眼患病率愈高,致盲和低视力率也愈高,但在麻风反应期或眼病早期及早诊治可保持正常视功能,说明麻风致盲可以预防。麻风性眼病以眼前部占绝大多数,致盲和低视力者以少菌型为多,这与少菌型易发生暴露性眼炎及其后遗症有关;多菌型发生虹睫炎者不多,但白内障的患病率却明显高于群体中的患病率,可能与麻风菌产生多巴(致障物质)、虹睫炎及晶体营养差有关。广东麻风院中约有6000例眼病,600多盲人,近1000人低视力。全国4万余住院病人,院外者过30万,有眼疾者更多,应有计划地分期训练麻风医生並发动眼科界共同做好麻风眼病的防治。     

麻风病

960046 麻风患者盲和低视力的原因/刘晓娟//中国麻风杂志。-1995,11(3).-131～132 1994年12月对江苏当地的457例麻风患者眼病进行了调查,共检出盲目44例(9.62％),其中双眼盲13人(2.84％),单眼盲31人(6.78％);检出低视力71例(7.22％),单眼低视力38例(8.32％)。盲和低视力     

麻风眼盲及低视力的流行病学调查

按照世界卫生组织的标准，对四川凉山州和攀枝花市现存麻风患者进行视力残疾的随机抽样调查，实验２１４５人，其中双眼盲２０人，双眼低视力８０人，视力残疾率４．９４％；其首苛致因是角膜白斑和溃疡，与麻风的病期和型别，以及年龄、生活环境与文化程度有关。     

麻风眼盲及低视力的流行病学调查

按照世界卫生组织的标准,对四川凉山州和攀枝花市现存麻风患者进行视力残疾的随机抽样调查,实检2145人,其中双眼盲20人,双眼低视力80人,视力残疾率4.94％;其首要致因是角膜白斑和溃疡,与麻风的病期和型别,以及年龄、生活环境与文化程度有关。     

麻风眼病—1045的配对调查

对江苏泰兴市１０４５例麻风患者进行了眼病的配对调查，发现眼病率为６３．９２％，以眼前部和外眼损害为主。视残率为２７．１８％，盲占１２．０７％。视列珠主要原因是白内障、角膜病和虹膜病。配对者的眼病率为９．９５％，视残率为１．５３％，视残者以常见的老年性眼病为主。麻风眼病者中４２．５１％有视力损害，７０．４４％伴有手足的Ⅱ级畸残，明显地生活和劳动能力。     

麻风眼病——1045的配对调查

对江苏泰兴市1045例麻风患者进行了眼病的配对调查,发现眼病率为63.92％,以眼前部和外眼损害为主。视残率为27.18％,盲占12.07％。视残的主要原因是白内障(41.2％)、角膜病(33.45％)和虹膜病(17.25％)。配对者的眼病率为9.95％,视残率为1.53％,视残者以常见的老年性眼病为主。麻风眼病者中42.51％有视力损害,70.44％伴有手足的Ⅱ级畸残,明显地影响生活和劳动能力。麻风眼病与性别无明显关系,主要与型别、反应、面瘫、病程及抗麻风治疗是否规则有关,年龄、职业和居住地亦有影响。麻风眼病可防可治,但需要眼科医生的参予和提高麻风工作者识别眼病的能力,还要教育患者自觉地保护眼睛。     

14例麻风患者白内障术后8年报告

在麻风的残疾中,眼疾并发症约占一半左右.Hasting指出1:"任何疾病都不像麻风那样经常引起眼部病变."据有关资料对麻风患者与非麻风患者配对比较眼病的研究报道表明,麻风患者的眼患病率占63.9%.其中视残占27.18%,眼盲占12.0%,检查配对的人群中眼病9.95%,视残者占1.53%.两组比较,麻风眼病患者同龄性别配对者的50倍之多.其中以虹膜病变及继发性白内障为多,这是麻风患者致盲的原因之一.自2001年开始复明工程以来,复习国内有关报道,麻风患者白内障手术后随访最长为58个月,最短3个月,2-7 但对更长时间的随访报告,尚未见报道.我们对14例(眼)手术病人随访8年,报道如下.     

美克治疗体股癣、手足癣、花斑癣和皮肤念珠菌病疗效观察

目的评价美克(1%联苯苄唑乳膏)治疗体股癣、手足癣、花斑癣和皮肤念珠菌病的临床疗效和安全性。方法采用多中心、随机、平行对照的方法,试验组外用美克,对照组外用欣欣(1%盐酸布替萘芬乳膏)。结果体股癣患者停药时试验组与对照组痊愈率分别为42.20%和39.45%,有效率分别为94.49%和91.74%;停药2w时,试验组与对照组痊愈率分别为85.32%和82.56%,有效率分别为97.24%和96.33%。手足癣停药时试验组与对照组痊愈率分别为39.87%和37.34%,有效率分别为85.54%和84.81%;停药2w时,试验组与对照组痊愈率分别为59.49%和58.22%,有效率分别为89.24%和86.70%。花斑癣患者停药时试验组与对照组痊愈率分别为50.72%和52.17%,有效率分别为79.71%和76.81%;停药2w时,试验组与对照组痊愈率分别为66.67%和63.76%,有效率分别为84.05%和81.16%。皮肤念珠菌病患者停药时试验组与对照组痊愈率分别为34.88%和39.53%,有效率分别为72.09%和76.74%;停药2w时,试验组与对照组痊愈率分别为65.11%和67.44%,有效率分别为88.37%和86.04%。局部不良反应发生率各试验组合计为5.27%;各对照组合计为5.54%。上述各项指标,各病种试验组与对照组比较差异均无统计学意义。结论美克治疗体股癣、手足癣、花斑癣和皮肤念珠菌病安全有效。     

FS06.7The new fragrance mix II – test results of a multicentre European Study

A new fragrance mix (FM II) with 6 frequently used chemicals was evaluated in consecutive patients patch tested in 6 dermatological centres in Europe. 28% FM II contained 5% Lyral, 1% citral, 5% farnesol, 5% coumarin, 1% citronellol and 10% alpha‐hexyl cinnamic aldehyde (AHCA); in 14% FM II the single constituents’ concentrations was lowered to 50% and in 2.8% FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances: certain, probable, questionable and none. The frequency of positive reactions to the currently used 8% fragrance mix (FM I) and the new mix in 1703 patients was as follows: FM I, 6.6%; 2.8% FM II, 1.3%; 14% FM II, 2.9%; 28% FM II, 4.1%. The number of doubtful/irritant reactions was 7.2% for FM I and ranged from 1.8% to 10.6% for FM II. 8.7% of tested patients had a certain fragrance history. Of these 25.2% were positive to FM I, reactivity to FM II was dose‐dependent and ranged from 8.1% to 17.6% in this subgroup. Comparing 2 groups of history – certain and none – values for sensitivity (sens) and specificity (spec) were calculated. Sens: FM I, 27.2%; 2.8% FM II, 8.7%; 14% FM II, 15.9%; 28% FM II, 21.5%. Spec: FM I, 96.3%; 2.8% FM II, 99.5%; 14% FM II, 98.7%; 28% FM II, 97.9%. 31/70 (44.3%) patients positive to 28% FM II were negative to FM I. In the group of patients with a certain history a total of 6 patients was found reacting only to FM II. Simultaneous break‐down testing with the single constituents produced positive reactions in 54.3% for 28% FM II and 48% for 14% FM II. Lyral was the dominating single constituent with positive reactions (37.1% for 28% FM II, 36% for 14% FM II), followed by citral, farnesol, citronellol, AHCA and coumarin. Chemical analysis for the 6 constituents of FM II was performed on 25 products used by 12 patients being patch test positive to FM II. Lyral was detected in 76% of these products, citral in 16% and AHCA in 8%. In conclusion, the new FM II detects additional patients with contact allergy to fragrances missed by the currently used FM I. The medium concentration, 14% FM II, is probably the most useful one for diagnostic screening.     

Vitamin D receptor gene polymorphisms are not associated with alopecia areata

BACKGROUND: It has been demonstrated that the vitamin D receptor (VDR) is strongly expressed in key structures of hair follicles, and a lack of VDR leads to alopecia. We investigated whether there was any association between VDR gene polymorphisms (BsmI, ApaI, and TaqI) and alopecia areata (AA). METHODS: Thirty-two patients with AA and 27 healthy control subjects were genotyped using polymerase chain reaction and restriction fragment length polymorphism analysis. RESULTS: In the patient group, the B and b allele frequencies were 53.1% and 46.9%, A and a allele frequencies were 70.3% and 29.7%, and T and t allele frequencies were 62.5% and 37.5%, respectively. In the control group, the corresponding values were 51.9% and 48.1%, 63.0% and 37.0%, and 77.8% and 22.2%, respectively. In the patient group, the BB, Bb, and bb genotype frequencies were 25.0%, 56.2%, and 18.8%, AA, Aa, and aa genotype frequencies were 43.8%, 53.1%, and 3.1%, and TT, Tt, and tt genotype frequencies were 37.5%, 50.0%, and 12.5%, respectively. In the control group, the corresponding values were 11.1%, 81.5%, and 7.4%, 29.6%, 66.7%, and 3.7%, and 63.0%, 29.6%, and 7.4%, respectively. None of the allele or genotype frequencies showed statistically significant differences between the patient and control groups. CONCLUSION: These findings suggest that there is no relationship between VDR gene polymorphisms and AA.     

Comorbidities associated with psoriasis: An experience from the Middle East

Recent studies suggest that psoriasis patients have higher rates of comorbidities. We sought to determine the prevalence of comorbidities and co-medications in our psoriasis patients. We conducted case-control study in 1835 patients with psoriasis vulgaris and age- and gender-matched cohort without psoriasis. Patients were examined for clinical characteristics of psoriasis, PASI scores, and data of age, sex, body mass index (BMI), smoking status, comorbidities, and co-medications were analysed for both patients and controls. We identified 1661 (92.8%) patients with mild to moderate psoriasis (PASI < 10) and 129 patient's (7.03%) with severe psoriasis (PASI > 10). Patients with psoriasis were more likely to be current smokers (51.34% vs 32.51% controls). Respective prevalence rates of risk factors in those with mild–moderate psoriasis, severe psoriasis, and controls were as follows: inflammatory arthritis (20%, 31% and 10.68%); coronary heart disease (4.1%, 8.35% and 1.42%); obesity (BM1) (32.5%, 41% and 17%); diabetes mellitus type II (37.4%, 41% and 16%); hypertension (32%, 40.3% and 11.55%); dyslipidemia (14.1%, 22.48% and 4.96%); metabolic syndrome (16%, 26.35% and 6.76%); chronic obstructive pulmonary disease (COPD) (5.36%, 6.98% and 4.03%); cancer (0.3%, 1.55% and 0.16%). They had a higher odds of inflammatory arthritis, coronary heart disease, obesity, diabetes mellitus II, hypertension, dyslipidemia, and metabolic syndrome. They were receiving significantly wider varieties of drugs. Which most commonly included antidiabetic drugs, antihypertensives, and hypolipidemic drugs.     

健康人和病人各型舌苔真菌带菌情况调查初报

本文报告对262例病人和102名健康人舌苔真菌带菌情况的调查,其结果显示:舌苔的真菌带菌率分别为白苔70.1%和29.1%,黄苔60.5%和29.7%。在病人中黑苔为83.3%,灰苔为33.3%,其中按菌种计白念珠菌的带菌率为8.4%和2.9%,其他,念球菌为28.2%与6.9%,酵母菌18.3%与11.8%,曲菌7.6%与4.9%,青霉菌2.7%与1.9%,毛霉菌1.2%与1.0%,地丝菌0.4%与0,总带菌率为66.8%与29.4%,两组的差异具有非常明显的统计学意义(P<0.001)。白念珠菌带菌率白苔高于黄苔,这与口腔内的pH值及病人的年龄相关。     

皮肤镜诊断黑素细胞痣、脂溢性角化和日光性角化与组织病理诊断的一致性

目的：评价皮肤镜诊断黑素细胞痣、脂溢性角化、日光性角化的准确度。方法：收集临床怀疑为黑素细胞痣、脂溢性角化和日光性角化的病例,由两位医生参照目前皮肤镜诊断标准对该三种皮肤肿瘤进行盲法独立诊断,并与组织病理结果相对照。结果：与组织病理诊断比较,(1)A、B两位医生使用皮肤镜诊断黑素细胞痣一致率（89.3%、91.2%）、灵敏度（94%、95.2%）、特异度（84.2%、86.8%）、误诊率（15.8%、13.2%）、漏诊率（6%、4.8%）。(2)A、B两位医生使用皮肤镜诊断脂溢性角化一致率（88%、91.7%）、灵敏度（91.7%、95.8%）、特异度（83.6%、86.9%）、误诊率（16.4%、13.5%）、漏诊率（8.3%、4.2%）;(3)A、B两位医生使用皮肤镜诊断日光性角化一致率（84.1%、86.4%）、灵敏度（87.5%、87.5%）、特异度（17.9%、12.5%）、误诊率（82.1%、85.7%）、漏诊率（17.9%、14.3%）。结论：皮肤镜诊断黑素细胞痣、脂溢性角化和日光性角化的结果与病理诊断结果均有较好的一致性。     

Patch testing with a new fragrance mix detects additional patients sensitive to perfumes and missed by the current fragrance mix

The currently used 8% fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patients patch tested in 6 dermatological centres in Europe. FM II was tested in 3 concentrations - 28% FM II contained 5% hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral), 2% citral, 5% farnesol, 5% coumarin, 1% citronellol and 10%alpha-hexyl-cinnamic aldehyde; in 14% FM II, the single constituents' concentration was lowered to 50% and in 2.8% FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances: certain, probable, questionable, none. Positive reactions to FM I occurred in 6.5% of the patients. Positive reactions to FM II were dose-dependent and increased from 1.3% (2.8% FM II), through 2.9% (14% FM II) to 4.1% (28% FM II). Reactions classified as doubtful or irritant varied considerably between the 6 centres, with a mean value of 7.2% for FM I and means ranging from 1.8% to 10.6% for FM II. 8.7% of the tested patients had a certain fragrance history. Of these, 25.2% were positive to FM I; reactivity to FM II was again dose-dependent and ranged from 8.1% to 17.6% in this subgroup. Comparing 2 groups of history - certain and none - values for sensitivity and specificity were calculated: sensitivity: FM I, 25.2%; 2.8% FM II, 8.1%; 14% FM II, 13.5%; 28% FM II, 17.6%; specificity: FM I, 96.5%; 2.8% FM II, 99.5%; 14% FM II, 98.8%; 28% FM II, 98.1%. 31/70 patients (44.3%) positive to 28% FM II were negative to FM I, with 14% FM II this proportion being 16/50 (32%). In the group of patients with a certain history, a total of 7 patients were found reacting to FM II only. Conversely, in the group of patients without any fragrance history, there were significantly more positive reactions to FM I than to any concentration of FM II. In conclusion, the new FM II detects additional patients sensitive to fragrances missed by FM I; the number of false-positive reactions is lower with FM II than with FM I. Considering sensitivity, specificity and the frequency of doubtful reactions, the medium concentration, 14% FM II, seems to be the most appropriate diagnostic screening tool.     

1%盐酸布替萘芬乳膏治疗体股癣、足癣疗效观察

目的：评价1％盐酸布替萘芬乳膏治疗体股癣、足癣的临床疗效和安全性。方法：采用多中心、随机、双盲、平行对照的方法．试验组外用1％盐酸布替萘芬乳膏，对照组外用1％联苯苄唑乳膏。结果：体股癣患者停药时试验组与对照组痊愈率分别为32．76％和38．98％。有效率分别为93．10％和94．92％；停药2周时，试验组与对照组痊愈率分别为62．07％和64．41％，有效率分别为93．10％和96．61％。足癣患者停药时．试验组与对照组痊愈率分别为29．31％和30．00％．有效率分别为89．66％和85．00％；停药2周时，试验组与对照组痊愈率分别为48．28％和43．33％．有效率分别为91．38％和86．67％。局部不良反应发生率，两试验组为5．13％；两对照组为4．17％。上述各项指标，两组比较差异无统计学意义。结论：1％盐酸布替萘芬乳膏治疗体股癣、足癣安全有效。     

尖锐湿疣患者外周血单一核细胞共刺激分子CD28,CD40的检测

目的探讨免疫共刺激分子CD28/CD152-CD80/CD86,CD40-CD40L在尖锐湿疣患者外周血单一核细胞(PBMC)中的表达情况。方法采用流式细胞仪(FCM)检测60例CA患者(初发组30例、复发组30例)和30例健康对照者外周血CD28,CD152,CD40L在CD4+,CD8+T细胞上CD80,CD86,CD40在CD19+B细胞上的表达水平。结果CA患者CD28,CD40L在CD4+,CD8+T细胞的表达,与对照组(42.36%,13.85%,5.08%,2.58%)相比,复发组(37.10,11.66%,2.57%,1.25%)较初发组(39.69%,12.76%,3.93%,1.96%)明显降低(P<0.01);CD80,CD86,CD40在CD19+B细胞上的表达与对照组(1.59%,3.83%,14.25%)相比,复发组(0.65%,3.05%,10.24%)较初发组(1.04%,3.45%,12.21%)显著降低(P<0.01),而CD152在CD4+,CD8+T细胞上的表达与对照组(1.71%,9.62%)相比,复发组(39.2%,12.15%)较初发组(2.64%,10.90%)显著增高(P<0.01)。结论尖锐湿疣患者外周血淋巴细胞CD28/CD152-CD80/CD86,CD40-CD40L共刺激分子的异常表达可能与其免疫功能紊乱及复发机制有一定关系。     

Targeted and combination treatments for vitiligo. Comparative evaluation of different current modalities in 458 subjects

The current treatment of vitiligo is not satisfactory according to the opinions of both the patient population and the dermatologists. Recently, combination therapies have been introduced, which are both systemic and targeted (microphototherapy). To evaluate the effects of topical treatments given alone or in combination with 311-nm narrow-band microphototherapy. We evaluated the efficacy and safety of: (1) 311-nm narrow-band microphototherapy;(2) tacrolimus 0.1% ointment twice a day; (3) pimecrolimus 1% cream twice a day; (4) betamethasone dipropionate 0.05% cream twice a day; (5) calcipotriol ointment 50 microg/g twice a day; and (6) 10%l-phenylalanine cream twice a day, for the treatment of exclusively vitiligo patches. A 311-nm narrow-band microphototherapy (Bioskin) was given alone or in combination with the above-mentioned popular local treatments. Four hundred and seventy patients suffering from vitiligo that affected less than 10% of the skin surface were evaluated. The patients were divided into 11 groups according to the selected treatment modalities. Four hundred and fifty-eight patients completed the study period of 6 months. Excellent repigmentation (> 75%) was achieved by 72% of the patients in group 1, 76.5% in group 2, 76.1% in group 3, 90.2% in group 4, 75.6% in group 5, 74.8% in group 6, 61% in group 7, 54.6% in group 8, 71.2% in group 9, 59.1% in group 10, and 29.3% in group 11. Marked repigmentation (50-75%) was evident in 19.8% of the patients in group 1, 18.2% in group 2, 20.1% in group 3, 6.7% in group 4, 14.1% in group 5, 11.3% in group 6, 16.1% in group 7, 18.4% in group 8, 25% in group 9, 10.6% in group 10, and 8.1% in group 11. Moderate results (25-50% repigmentation) were seen in 4.6% of the patients in group 1, 3.3% in group 2, 2.7% in group 3, 2.2% in group 4, 7.4% in group 5, 10.1% in group 6, 18.4% in group 7, 21.7% in group 8, 2.1% in group 9, 27.1% in group 10, and 55% in group 11. Finally, minimal (< 25%) or no response was achieved in 3.6% of the patients in group 1, 2% in group 2, 1.1% in group 3, 0.9% in group 4, 2.9% in group 5, 3.8% in group 6, 4.5% in group 7, 5.3% in group 8, 1.75% in group 9, 3.2% in group 10, and 7.6% in group 11. Side effects were skin atrophy (76% in group 4 and 81% in group 9), stinging and burning (groups 2, 3, 7, and 8). Targeted combination therapies in vitiligo are remarkably more effective than single treatments. When single treatments are considered alone, 311-nm narrow-band UVB microfocused phototherapy and 0.05% betamethasone dipropionate cream are the most effective treatments in our study. When combined therapies are chosen, 0.05% betamethasone dipropionate cream plus 311-nm narrow-band UVB microfocused phototherapy apparently give the highest repigmentation rate. In the short term, the only side-effects registered have been cutaneous atrophy with corticosteroid cream, and stinging and burning with 0.1% tacrolimus ointment and, less frequently, with 1% pimecrolimus cream.