胫前黏液性水肿严重程度和活动度评分量表的建立及实验室、超声相关指标的验证

doi:10.16150/j.1671-2870.2020.03.008

摘要/Abstract

摘要：

目的： 观察自建胫前黏液性水肿（pretibial myxedema, PTM）严重程度和活动度评分量表在PTM临床量化评估中的应用价值,采用超声测量皮损真皮厚度,并检测血清促甲状腺激素受体抗体（thyroid stimulating hormone receptor antibody, TRAb）水平,以验证量表的临床价值。方法： 参照温哥华瘢痕评定量表和PTM皮损分期,建立胫前黏液性水肿严重程度和活动度评分量表。2015年1月至2018年12月期间,收集上海交通大学医学院附属瑞金医院皮肤科诊断为PTM的患者40例,根据其皮损临床表现,进行PTM严重程度和活动度评分,进一步分析该评分与患者血清TRAb水平、超声测量皮损真皮厚度间的相关性。结果： 对40例患者进行PTM严重程度和活动度评分,最高者为11分,最低者为3分,平均分为（7.2±1.9）分。所有患者的血清TRAb水平均高于正常值参考范围（<1.75 IU/L）,其中31例（77.5%）>40 IU/L,7例（17.5%）在30~40 IU/L之间,2例（5.0%）在20~30 IU/L之间。经超声测量患者的皮损真皮厚度为4.2~10.4 mm,平均厚度为（6.4±1.6） mm。Spearman相关分析表明,PTM严重程度及活动度评分与血清TRAb水平、超声测量皮损真皮厚度呈正相关（r=0.616,r=0.680,P均<0.05）。结论： PTM严重程度和活动度评分量表有良好的临床量化评估PTM严重程度、活动度的价值,其与患者的血清TRAb水平、超声测量皮损真皮厚度呈正相关。

关键词: 胫前黏液性水肿, 严重程度和活动度评分, 促甲状腺激素受体抗体, 皮肤厚度, 超声

Abstract:

Objective: To establish a rating scale for assessing severity and activity of pretibial myxedema (PTM) and to validate its application value by ultrasonic measurement of skin thickness and detection of thyroid stimulating hormone receptor antibody(TRAb). Methods: The PTM severity and activity rating scale was established based on Vancouver scars scale and PTM skin lesion staging. A total of 40 PTM patients were enrolled during January 2015 to December 2018 and severity and activity of PTM referring to the clinical manifestation and skin lesion were assessed. The correlation of scale score with serum TRAb level and skin dermal thickness in the lesions measured by ultrasound were further analyzed. Results: Scores of PTM severity and activity rating scale ranged from 3 to 11, with an average of 7.2±1.9. The serum TRAb level in all patients were higher than normal (<1.75 IU/L): 31 cases (77.5%)> 40 IU/L, 7 cases (17.5%) between 30-40 IU/L, and 2 cases (5%) between 20-30 IU/L. The skin dermal thickness obtained by ultrasonic measurement ranged from 4.2 to 10.4 mm, with an average of (6.4±1.6) mm. Spearman analysis showed the rating scores had a positive correlation with serum TRAb level (P<0.05) and skin dermal thickness (P<0.05). Conclusions: The pretibial myxedema severity and activity rating scale is a valua-ble method to assess the degree of PTM severity and activity, and was also easy and helpful to describe the disease accurately.

Key words: Pretibial myxedema, Severity and activity score, Thyroid stimulating hormone receptor antibody, Skin thickness, Ultrasound

中图分类号:

R751

陈小英, 郑捷. 胫前黏液性水肿严重程度和活动度评分量表的建立及实验室、超声相关指标的验证[J]. 诊断学理论与实践, 2020, 19(03): 243-247.

CHEN Xiaoying, ZHENG Jie. Establishment of pretibial myxedema severity and activity rating scale and validation with ultrasonic and laboratory measurements[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(03): 243-247.

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项目	评分（分）
皮损范围（单侧）
≤5 cm×5 cm或结节、斑块≥1个	1
>5 cm×5 cm或结节、斑块≥3个	2
>10 cm×10 cm或结节、斑块≥5个,或象皮病样型	3
皮损颜色
皮色	1
粉红色	2
褐色	3
皮损质地
柔软	1
坚硬	2
纤维化	3
自觉症状[疼痛和（或）瘙痒]
有	1
无	0
1个月内有进展^a）
有	1
无	0