【作者】 刘悦；

【导师】 张玉环；

【作者基本信息】 天津医科大学 ， 皮肤病与性病学， 2008， 硕士

【摘要】 目的:探讨性激素在围绝经期及绝经后女性家庭主妇手部湿疹(Housewife’s HandDermatitis,HWHD)患者发病中的作用及其机制,以观察中老年女性卵巢功能衰退是否成为影响HWHD发生、发展及转归的重要因素之一,为临床家庭主妇手部湿疹的治疗提供理论依据和新的治疗方案。方法:1、详细记录患者病史、接触史、家族过敏史、过敏原及斑贴试验检测结果。2、采用双抗体放射免疫分析法对病例组和正常对照组的雌二醇(Estrogen,E2)、卵泡刺激素(Follicle Stimulating Hormone,FSH)、黄体生成素(LuteinizingHormone,LH)、睾酮(Testosterone,T)、孕激素(Progesterone,P)及催乳素(Prolactin,PRL)进行测定,比较二者之间有无统计学意义。3、对患者皮损做详细检查,并依照手部湿疹严重程度评分表(Hand eczemaseverity Index,HECSI)进行量化评分,对HECSI评分与雌二醇进行线性相关统计学分析。结果:1、HWHD的发病和加重与接触各种外界因素有关,其中以经常接触各种洗涤剂、过度洗拭、暴力搔抓为主要诱发因素。2、个人过敏史及家族史:45例患者中自述既往曾患过敏性疾病或有家族过敏史者35例(77.78%)。其中曾经患湿疹者8例(17.78%),荨麻疹者13例(28.89%),过敏性鼻炎者17例(37.78%),过敏性哮喘者5例(11.11%),家族中二代亲属以内有过敏性疾病史者15例(33.33%)。3、过敏原测定及斑贴试验结果:45例患者中,有30例过敏原检测阳性(66.67%),25例斑贴试验检测阳性(55.56%)。4、临床表现:45例患者均有不同程度的瘙痒,影响睡眠者38例(84.4%);双手同时发病38例(84.4%),其中以手指和指尖最易受累。根据皮损情况分为急性期4例(8.89%)和慢性期41例(91.11%)。5、通过对45例女性患者体内六项性激素水平进行测定,并与健康对照组进行比较,我们发现HWHD组外周血的E2值水平(44.13±33.18)显著低于对照组(57.12±3.78),二者具有明显差异性(P＜0.05),有统计学意义;而HWHD组外周血的T值水平(0.39±0.17)显著高于对照组(0.32±0.14),二者具有明显差异性(P＜0.05),有统计学意义。在对两组实验组另四项性激素(FSH、LH、P、PRL)水平的测定和比较中,我们发现孕激素及催乳素的水平在病例组和对照组中均呈下降趋势,卵泡雌激素和黄体生成素的水平在病例组和对照组中均呈不同程度的上升趋势,但尚未发现明显差异性(P＞0.05),无统计学意义。6、通过计算FsH/LH值,我们发现HWHD组FsH/LH＞1.0的患者所占比例(57.78%)明显高于对照组(50.19%),两组之比值未发现明显差异性(P＞0.05),无统计学意义。根据HWHD组FsH/LH值,我们将45例患者分为绝经组和围绝经组,并分别计算了六项性激素水平与两组患者手部湿疹严重程度量化评分(HECSI)的相关系数r。经比较,我们发现绝经组和围绝经组E2与HECSI的r值均为-0.699(P＜0.01),有统计学意义,说明E2与HWHD的临床表现存在一定的负相关,提示雌二醇可能在促进HWHD的发展及病情的加重均有影响。结论:1、频繁接触水和洗涤剂中的碱性化学物质以及经常烫洗、热敷等物理性刺激是引起HWHD发病的主要外界影响因素。2、45例患者中既往曾患过敏性疾病或有家族过敏史者占77.78%,提示遗传性过敏因素的存在及个体对食物、化学物质的个体敏感性差异是诱发HWHD发病的内在性因素。3、45例女性患者皮损多累及双手,以慢性皮炎湿疹样改变为主。临床症状以瘙痒为主,并不同程度地影响睡眠。4、HWHD组外周血的E2值水平(44.13±33.18)显著低于对照组(57.12±3.78),二者具有明显差异性(P＜0.05),有统计学意义;而HWHD组外周血的T值水平(0.39±0.17)显著高于对照组(0.32±0.14),二者具有明显差异性(P＜0.05),有统计学意义。提示我们雌激素水平下降可能与HWHD的发病及复发有关。5、E2与HWHD的临床表现有较为肯定的负相关(P＜0.05),提示我们HWHD的复发和病变加重与E2水平的下降有关。更多还原

【Abstract】 Objective:Housewife’s Hand Dermatitis(HWHD) is a special term which is used to describe a kind of hand eczema ,which is mostly found among house-wives ,especially who are in greater contact with soap,detergents and water and still deal with housework. Housewife’s Hand Dermatitis is a chronic irritant contact dermatitis .The aim of our study is to investigate the serum hormone level among patients and healthy women and explore the action and mechanism of hormone in HWHD .Methods:1、A survey of HWHD ,based on a questionnair, was carried out among 45 female patients.The questionnair includee questions on patient history,occupation, the frequence of household work, contacting materials ,antigents, patch testing, family allergic history ,etc.2、Bi-Antibodies Radioimmunoassy was used to measure the serum estrogen(Estrogen,E2),Follicle Stimulating Hormone(Follicle Stimulating Hormone,FSH) ,Luteinizing Hormone(Luteinizing Hormone,LH), Prolactin(Prolactin,PRL),Testosterone(Testosterone,T),Progesterone (Progesterone,P) among the 45 patients and 55 healthy women. And find the differences between the two groups.3、We examined and recorded the symtoms and locations of every patient by a Hand eczema severity Index (HECSI) detailedly.45 HWHD cases were investigated by a log-linear analysis method to evaluate the interaction of clinical manifestation and serum E2 levels.Results:1、Exogenous factors: Contacting with detergents , excessive washing and physical friction were identified as causing or contributing to the HWHD in 45 female patients. 2、Personal and family allergic history: In the 45 cases of the observation group ,35 cases or their family were said to have allergic diaeases .3、Allergic test and patch test: In the 45 cases of the observation group ,30cases were detected to have positive allergic test reaction and 15 cases have positive patch test reaction.The main allergens were fish,shrimps,cracks,eggs,milk,farinate,et al in allergic test. There are 10 cases(40.00%) have 4 kinds of positive allergens,9 cases (4.00%) have kinds of positive allergens, 5 cases(20.00%) have 2 kinds of positive allergens, 1 cases(36.00%) have 1 kinds of positive allergens. 4、Clinical manifestation: All of the 45cases suffered from itch in different degrees and 43 cases of them were observed to be revolved in both hands (84.44%).5、According to the results of testing on hormone, observation group (44.13±33.18) showed significantly lower E2 levels than control values (57.12±3.78) , and the comparison between the two groups has significance (P<0.05). Otherwise, observation group (0.39±0.17) showed significantly higher T levels than control values(0.32±0.14), and the comparison between the two groups has significance (P<0.05). Both observation and control groups showed downtrends on P and PRL ,meanwhile both of the two groups showed uptrends on FSH and LH ,without significance (P>0.05).The cases of FSH/LH>1.0 in the observation group are more than control group.6、According to the FSH/LH values,45 cases of HWHD are classified into peri-menopausal and menopausal groups.Meanwhile ,we evaluated the r(Pearson Correlation Cofficients) between hormones and HESCI.In the two groups, the r of E2 and HESCI both are -0.699,which is indicated a negative relationship between E2 levels and clinical menifestations.Conclusion:1、The main exogenous factors of HWHD is contacting with water and slkalinechemical materials in detergents.2、35 cases of HWHD had once allergic diseases or allergic family history ,whichindicated the heritage hypersensitiveness and heterogeneity of being allergic to foodand chemical materials are the endogenous factors of HWHD.3、All of the 45cases suffered from itch in different degrees and 43 cases of them wereobserved to be revolved in both hands.Besides,the HWHD are mainly stay in thechronic periods.4、Observation group (44.13±33.18) showed significantly lower E2 levels thancontrol values (57.12±3.78) , and the comparison between the two groups hassignificance (P<0.05). Otherwise, observation group ( 0.39±0.17 ) showedsignificantly higher T levels than control values(0.32±0.14), and the comparisonbetween the two groups has significance (P<0.05). It is indicated that the decline of serum E2 level may cause the occurrence and relapse of HWHD.5、It is recognized that there is a negative relationship between E2 levels and clinical menifestations(P<0.05),which indicated that E2 may have adverse influence on the relapse and aggravation of HWHD.更多还原