中华皮肤科杂志 ›› 2020, Vol. 53 ›› Issue (9): 675-679.doi: 10.35541/cjd.20200376

• 论著 • 上一篇    下一篇

中国玫瑰痤疮临床特征分析和诊断标准再探讨

汪犇1    赵志祥1    简丹1    施为1    刘芳芬1    刘慧2    余斌3    夏建新4    杨洁5    吴琳6    鞠强7    李吉1    谢红付1   

  1. 1中南大学湘雅医院皮肤科  国家老年疾病临床医学研究中心(湘雅),长沙  410008;
    2广西医科大学第一附属医院皮肤科, 南宁  530021;3福建医科大学附属第二医院皮肤科,福建泉州  362000;4吉林大学第二医院皮肤科,长春  130041;5华北理工大学附属医院皮肤科,河北唐山  063000;6北京大学深圳医院皮肤科,深圳  518036;7上海交通大学附属仁济医院皮肤科  201112
  • 收稿日期:2020-04-17 修回日期:2020-07-23 发布日期:2020-08-31
  • 通讯作者: 李吉;谢红付 E-mail:liji_xy@csu.edu.cn; xiehongfu@csu.edu.cn
  • 基金资助:
    国家自然科学基金(81773351、81974480)

Analysis of clinical features of rosacea and rediscussion of a Chinese diagnostic criterion for rosacea

Wang Ben1, Zhao Zhixiang1, Jian Dan1, Shi Wei1, Liu Fangfen1, Liu Hui2, Yu Bin3, Xia Jianxin4, Yang Jie5, Wu Lin6, Ju Qiang7, Li Ji1, Xie Hongfu1#br#   

  1. 1Department of Dermatology, Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, Changsha 410008, China; 2Department of Dermatology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; 3Department of Dermatology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian, China; 4Department of Dermatology, The Second Hospital of Jilin University, Changchun 130041, China; 5Department of Dermatology, North China University of Science and Technology Affiliated Hospital, Tangshan 063000, Hebei, China; 6Department of Dermatology, Peking University Shenzhen Hospital, Shenzhen 518036, China; 7Department of Dermatology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 201112, China
  • Received:2020-04-17 Revised:2020-07-23 Published:2020-08-31
  • Contact: Li Ji; Xie Hongfu E-mail:liji_xy@csu.edu.cn; xiehongfu@csu.edu.cn
  • Supported by:
    National Natural Science Foundation of China (81773351, 81974480)

摘要: 【摘要】 目的 在分析玫瑰痤疮临床特征的基础上,提出中国玫瑰痤疮诊断标准并验证其敏感性和特异性。方法 纳入2017年12月至2018年7月于中南大学湘雅医院皮肤科门诊初诊的3 350例玫瑰痤疮患者,分析患者表型及临床特征,提出改良版中国玫瑰痤疮诊断标准。全国28个中心对该标准进行临床验证,纳入2 269例玫瑰痤疮和2 408例其他面部皮肤病患者,与2017版美国国家玫瑰痤疮专家委员会(NRSEC)制订的国际诊断标准比较,评估其敏感性和特异性。结果 3 350例玫瑰痤疮患者均存在面中部持续性红斑(100%)。在1 861例主要表现为面颊部红斑的患者中,1 850例(99.4%)在红斑之前或同时出现阵发性潮红;在1 489例主要表现为鼻或口周部红斑的患者中,仅52例(3.5%)发生阵发性潮红; 342例有肥大增生的患者均在肥大增生改变之前发生持续性红斑。基于以上临床特征提出,面颊部可周期性加重的伴有阵发性潮红的持续性红斑,可诊断为玫瑰痤疮;对于表现为鼻、口周部持续性红斑的患者,需合并至少1项选择性表型(阵发性潮红、毛细血管扩张、丘疹脓疱、肥大增生改变或眼部症状)才可诊断为玫瑰痤疮。全国多中心临床验证结果显示,改良版中国玫瑰痤疮诊断标准敏感性为99.6%,接近国际标准100%,特异性为91.9%,而国际标准为73.3%。结论 改良版中国玫瑰痤疮诊断标准具有良好的敏感性和特异性,也更有利于增生肥大型玫瑰痤疮的早期诊断。

关键词: 红斑痤疮, 诊断, 红斑, 潮红, 面中部持续性红斑

Abstract: 【Abstract】 Objective To propose a Chinese diagnostic criterion for rosacea on the basis of clinical feature analysis of rosacea, and to assess its sensitivity and specificity. Methods A total of 3 350 Chinese patients with newly diagnosed rosacea were collected from Department of Dermatology, Xiangya Hospital, Central South University between December 2017 and July 2018, their phenotypes and clinical features were retrospectively analyzed, and a Chinese modified diagnostic criterion for rosacea was put forward. A national multi-center clinical observational trial, which included 2 269 patients with rosacea and 2 408 patients with other facial skin diseases from 28 centers, was conducted to verify this diagnostic criterion. Then, the sensitivity and specificity of the modified diagnostic criterion were evaluated by comparing with the 2017 standard classification of rosacea developed by the National Rosacea Society Expert Committee (NRSEC). Results Fixed centrofacial erythema occurred in 3 350 (100%) patients with rosacea. Flushing occurred before or simultaneously with fixed erythema in 1 850 (99.4%) of the 1 861 patients with erythema on the cheeks; among the 1 489 patients with erythema on the nose or perioral area, only 52(3.5%) had flushing; all the 342 patients presenting with phymatous changes had fixed erythema before phymatous changes. Based on the above clinical findings, it was proposed that patients with periodically aggravated fixed erythema on the cheeks accompanied with flushing could be diagnosed with rosacea; patients with fixed erythema on the nose and perioral area accompanied with at least one of selective phenotypes (flushing, telangiectasia, papules and pustules, phymatous changes, or ocular manifestations) could be diagnosed with rosacea. The national multi-center clinical observational trial revealed that the sensitivity of the Chinese modified diagnostic criterion for rosacea was 99.6%, which was close to the sensitivity (100%) of the NRSEC standard, and its specificity was 91.9%, higher than the specificity (73.3%) of the NRSEC standard. Conclusion The Chinese modified diagnostic criterion for rosacea has good sensitivity and specificity, and can facilitate the early diagnosis of phymatous rosacea.

Key words: Rosacea, Diagnosis, Erythema, Flushing, Fixed centrofacial erythema