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֢״ؽʹ 쳣Ѣ м ɫ쳣 ָ쳣 ŧ

мPsoriasis׳ţƤѢҽѧмΪ“ׯH”dzԣԣ֢ԵƤdzִСȵߣ渲ɫм߽÷ͷƤ֫༰ԶŮԡ׸أ^໺⡣

IJвȫȷѧΪŴȾлϰ߹ϰڷϰйء

1.Ŵ  ٴмʷŴ򡣹мʷ30%50%иǿ100%ڱмʷΪ10%20%ңŴʽΪϵȾɫŴвȫʣΪϵȾɫŴŴߡ˫֮һмᷢʽϽŮ3֮࣬˫׽Իмᷢʸߡ

֯ݿԭHLAмԡⱨмHLA-B13HLA-B17ĿԭƵߣбмHLA-B3HLA-CT7HLA-W6ߡҹм߳HLA-B13HLA-B17ԭ⣬HLA-DR7HLA-A19ƵҲߡHLA-BW35HLA-DR9HLA-C7HLA-DQƵʽ͡ĿǰΪмܶĿƣͬʱҲܻصӰ졣

2.Ⱦ  ٴʵ֤мķϺȾͱйء6%мʲȾʷǷֺܶͯмйϵһλĸ׺ͬʱԱףƺ˷мֲÿЧժٺƤԺתˣ˵ȾмһҪء

еѧΪķ벡Ⱦйء֤ʵڼϸ԰壬Ҳ˷ڡϽн֣ƱƤ֣֯Ƭзְ塣䷢ʽռ7.5%ڼ̥Ͻʵ֣ɹΪ86.7%ϸ˷ʢǺᣨDNA࣬˲ѧ˵һݣδ

о˾ϸHCMVȾм֮Ĺϵ86мѪHCMVԿIgMIgAHCMV-DNAʡʾмHCMVԸȾԸڶ飬ҲHCMV-DNAҲԸڶ飬˵мڴŻHCMVȾ䷢HCMVһϵ

3.лϰ  мѪҺѧƤ֯ѧƤоδܻijɹȥΪмķ֬лйءĿǰڱIJѲΪ֬ʴлġøлĸıо˵ıƤøмߵƤȱж֣Ƥø³֪֡мƤȱٸʣcAMPһֱƤأEpidermal chaloneƱƤϸѣϸʧ֮ƽ⡣һcAMPмữøãҲӰԭĴлƤԭ࣬Ƥϸ˿ӣת졣мĴл쳣Ƕ෽ģǽcAMPȱƤڻգcGMP뻨ϩᣬషӶԱƤϸֳҲҪá

ֵеѧΪھƤϸֳͷֻУcAMPcGMPıdzҪм߱ƤϸֳֻȫԭԭڵcAMP͸cGMPδȫ֤ʵ

ջøĻмб쳣ضԴøĴ̼ӦܵͣǰE2ӦϸߣмıƤϸĤβ-ǽ͵ġǰڵڻҲҪáϸӦֱӶϸ߷ʵĺϳɷáҲcAMPֱӵDNAĺϳɣcAMPϸѺøɷֱá

4.߹ϰ  мߵĹϵһֱܵ㷺ӡٴƼõаʣMTXǰAƱЧмߴڶ־ֲϵͳ߹쳣HLAB13B17ȿԭ߶صȾʾҲһԼĿǰڱ߷δȫȽеĿǣмɻTϸıƤϸԼмƤƤлTϸЩϸͷγ-أյƤϸϳӺͰϸ8ϸ6ϸӵȣϸڱƤ󣬵ƤѪţƤ֢ⵥϸͱƤϸͷŵİϸ6Ͱϸ8ȻǴٽƤϸɴʹмƤγ˱Ƥ쳣Ƥ֢IJмƤTϸʼأдһоȾˡ񾭾صйء

5.ڷϰ  м뼤صĹϵܵǵӡ䣬ڣ¾йءٴϹ۲쵽мƤˡChuzch۲43ڼ38%Ƥˣл͵ȱ169м6.2%ڷйأ5ʱƤȬᣬӾ硣մȱⶨ191245ŮмѪĴƶˮƽԸ飬ѪͪˮƽԵ顣ΪѪƶˮƽ߼ͪˮƽĽͿܴٷ1245ŮмߵƤ𡣵еĸŮƤӾ񻯣ҲеʹóЧҩƱһЧıɼڷڵı仯һϵ

6.  羫Ĵˣ˻ʪѪҺѧĸı䣬Լؼҩ̼ȣмߵķҲһϵ

 

֢״

ѰмIJ仯DZƤǻȼǻȫǻȫڿɼ԰ϸɵСŧףMunroСŧסԼٻʧ񡣱Ƥͻ죬¶ڽƤͻǺϣƤͷӳ״Ϸ䱡ͷëϸѪųѪٴϳAuspitzΧɼϸ԰ϸȽ

ؽмIJ仯Ѱмͬڴ˲ظ

ƤмIJ仯ҪΪ֢ӦȽԣƤϲˮѰмơ

ŧм֫Ƥ׵IJ仯صڱƤγɽϴŧ弴Kogojŧ壬ҪڱƤϲҪΪ԰ϸ仯ѰмͬǻȫƤͻᡣ

ŧ岡IJ仯ΪƤڵŧ壬д԰ϸϸƤdzܰϸ֯ϸ԰ϸ

ٴ֡

мٴͲһɷΪѰ͡ؽ͡ŧ͡ŧ岡Ƥ֫͡Ƥ͡

1.ѰмPsoriasis VulgarisٴΪ༱ԷѸȫǺɫغɫԺչΪغɫİ߿顣ƤϸǸм߽ڵ𺦿Իںϡ

мɫ񣬹ȥмɳְ͸ıĤ˳ΪĤ󡣰ȥĤֵ״ѪΪAuspitzĤAuspitzмԡЩ˵мֺӲÿ״ӰƤڹؽϵĺӲмѣʹƤѶеʹ

Ѱм𺦱仯϶࣬еƤΪмˮ״Ϊ״мϸСмλëƤ֬ٿڣΪëммÿ״Ϊÿ״ме𺦲ʵͼ״Ϊͼ״мٴ״Ǯ״Ϊ״Ǯ״м

Ѱмɷȫ֫ΪرⲿϥɶԳƷβͷƤҲɵҲԺȫ𺦲档ͷ𺦽ͷ״ѷָֺҲۣױ“״”ݲƽױʧȥҲԱ񣬳ʻһɫװ״룬Ե𺦿ɷڿڴͷȴ

ѰмƤַΪڣ

1  ɵƤ𲻼˶µƤ𲻶ϳ֡Ƥԣ֢ԣΧкΣмϺһ̣ˣˣȻеԴ̼Ƥһ714Ժ󣬴̼ΧƤֵм𺦣Ϊ˹мPsoriasis factitiaΪͬͷӦisomorphismK?ebne

2ֹ  Ƥûж仯Ƥ֣֢ᣬȶ

3  𺦵֢ˣƤСƽɫؼٰװ߻ɫسŰߡ׷ֲ˿ʼԵļԣƤأļˡԺɳڲٴȬɳò

Ծв̶ͬȵⱨмٵIJı䣬м߿ɰ鷢Ѫףβ쳣֬ԼԻĤĤףԻ߿ɳ־Һĸı䡣мߵмʱӦӡ

2.ؽмPsoriasis arthropathicaֳΪмԹؽסмƤ⣬йؽڵIJ䣬ؽ֢״ƤͬʱءһƤֹؽ֢״κιؽھۣϥĴؽڣҲָֺСؽڡ׵ؽڼĹؽڵͬɱַйؽͺʹޣɷΣƷʪԹؽ׵ı֡ʿƻԵĸıɲлٻΣΪԹؽм͹ؽмгԸռѪӿ죬ʪӳԡƤҲŨмĸı䡣Xʾֲ˹ؽڵı仯ʪԹؽͬʿоֲѸƣؽǻխв̶ͬȵĹؽʴ֯͡ԣ²

3.ŧмPsoriasis pustulose

мټԷƬԺߣѸںߵĻϳܼͷСɫưɫdz޾Сŧ壬泣ϸмڵĺ߿ɻںϣʻ״״Եн϶Сŧ塣ڶڣȫѸٷͣ޾Сŧ塣˳ȫʣкսиȣʳͣƤȸСؽʹԺŧ衣Ȼ⣬ѰмƤԺͻȻŴμἰأ˳̷Ⱦȫ˥߻Ρ˶Σ

ŧмȫɷΪ棬ԺѸ࣬ӼȫʱǻճĤָֺҲۡ߳й״ָֺ࣬׷ʺǻѣװ¿жѻŧ塣

4.ŧ岡Pasfulosis palmaris et plantaris ŧ岡ŧмPustular psoriasis of the palma and solesŧϸPustular bacterid

1ŧм  Ϊ޾ŧмŶ𺦳ƵĴСʼŹλҲԷչָֺ࣬ʱΪԳԺߣܿ޾Сŧ壬沢¡ŧλڱƤڣںϣһڸɺԽƤСмֳµŧ壬˷ѡָֺ׿۶ɫΡ׻Ƿʺм״ͻԾʹλвѰмƤ𣬻гƬŧм𺦡еIJй״ࡣ

2ŧϸ  ȷƻ׵룬ƺףҲӵIJ棬ʱΪˮ壬Ѹٱɲϸŧ壬ԺŧɺԽɫммԺµŧ֣˷ѣ꣬ƤԷ죬񣬱мЩ߾ֲʹŧϸԡ

3  𺦵֢ˣƤСƽɫؼٰװ߻ɫسŰߡ׷ֲ˿ʼԵļԣƤأļˡԺɳڲٴȬɳò

Ծв̶ͬȵⱨмٵIJı䣬м߿ɰбѪףβ쳣֬ԼԻĤĤףԻ߿ɳ־Һĸı䡣мߵмʱӦӡ

2.ؽмPsoriasis arthropathica  ֳΪмԹؽסмƤ⣬йؽڵIJ䣬ؽ֢״ƤͬʱءһƤֹؽ֢״κιؽھۣϥĴؽڣҲָֺСؽڡ׵ؽڼĹؽڵͬɱַйؽͺʹޣɷΣƷʪԹؽ׵ı֡ʿƻԵĸıɲлٻΣΪԹؽм͹ؽмгԸռѪӿ죬ʪӳԡƤҲŨмĸı䡣Xʾֲ˹ؽڵı仯ʪԹؽͬʿоֲѸƣؽǻխв̶ͬȵĹؽʴ֯͡ԣ²

3.ŧмPsoriasis pustulose

мټԷƬԺߣѸںߵĻϳܼͷСɫưɫdz޾Сŧ壬泣ϸмڵĺ߿ɻںϣʻ״״Եн϶Сŧ塣ڶڣȫѸٷͣ޾Сŧ塣˳ȫʣкսиȣʳͣƤȸСؽʹԺŧ衣Ȼ⣬ѰмƤԺͻȻŴμἰأ˳̷Ⱦȫ˥߻Ρ˶Σ

ŧмȫɷΪ棬ԺѸ࣬ӼȫʱǻճĤָֺҲۡ߳й״ָֺ࣬׷ʺǻѣװ¿жѻŧ塣

4.ŧ岡Pasfulosis palmaris et plantaris ŧ岡ŧмPustular psoriasis of the palma and solesŧϸPustular bacterid

1ŧм  Ϊ޾ŧмŶ𺦳ƵĴСʼŹλҲԷչָֺ࣬ʱΪԳԺߣܿ޾Сŧ壬沢¡ŧλڱƤڣںϣһڸɺԽƤСмֳµŧ壬˷ѡָֺ׿۶ɫΡ׻Ƿʺм״ͻԾʹλвѰмƤ𣬻гƬŧм𺦡еIJй״ࡣ

2ŧϸ  ȷƻ׵룬ƺףҲӵIJ棬ʱΪˮ壬Ѹٱɲϸŧ壬ԺŧɺԽɫммԺµŧ֣˷ѣ꣬ƤԷ죬񣬱мЩ߾ֲʹŧϸԡ

5.ƤмErythrodermic psoriasis мԺƤErythrodema psoriaticumƲԭʹԭѰмŧмתΪƤ֢ԭмӦô̼ԾҵҩڷijЩҩͻȻͣöɢΪڷƤ̴أҩз

ʱԭмƤλֳ죬ѸչɴƬȫƤ2/3ϳԳͣд״мƬ״“Ƥ”֣ͷƤдۻ衣ɳ“”ʽ“”״ƤѡָֺױǣΡзȣȫʣdzܰͽ״󣬰ϸߡƤֳ֢м𺦡IJ̽Ͼã׸

6.֫ƤףAcrodermatitis continua ƤףDermatitis repens֫Ƥ޾ԵŧΪΪŧмΪͬһҲΪŧмһͣҲвͬΪӦһ齫Ϊмһ

÷ˣ˺𣬳ʱΪһָֺ࣬޾Сŧ壬ԺŧɺԽ裬Ƥ¹棬µŧ֣𺦲չֱַָֺ㱳˲˺ٳΪȫԻչԶҪַ֡֫ˣżַǻճĤָֺ۱Ƚϳ׻ʧȥ󣬱Σʱм䣬״Ͽɷ޾Сŧ塣ԣ

Ƥϸ쳣֣

1.Ƥͻӳ²

2.Ƥͷӳˮס

3.ʧ

4.ǻȫ

5.MUNRO΢ŧס

ݱٴ֣رƤ֯ص㣬һ㲻ϡӦм

(1)м ߽߱׽ԣʰƬ״渲мɫγмɼİ͸ĤٹγĤɼ״ѪммҪ㡣
(2)֬Ƥ ߱ԵʮײᣬмٶʵɫԣγûбĤ󼰵״Ѫ
(3)õ忷 ÷ɼ֫ˣΪԲСƬ䳤߹ǼƤƷУмϸСܺ˺׸ʱһĸߣԺࡣ
(4)м ټмϱΧ֢΢ûбĤ󼰵״ѪûκԾ֢״
(5)״Ǵ ÷沿رպͱDZʵηֲ߾ɼëϸѪšмΪճмճܣмɼŵëҿڣмкܶ״ͻ𡣲վãɼήݣɫظı䡣
(6)ʪ ɱΪߣϸм䷢СȲߡʪоƤԳƣ̶ȽмΪأмϱɫɫ죬ˮ

֢

(1)ʼӪʶʧ ммƤĵʡάؼҶ֮ʧƤǨӶ겻ҷȫᵼµ͵Ѫ֢ӪƶѪٴΪ뵡ɫ԰ףڸð֢״ڲȷ“ɿ”Ӫ벻㣬ʹ֢״ء
(2)ŧм еѰм߻ͻȻȡؽʹȫʼϸߣƤѸٳСܼСŧ塣ŧɴƬɺԺƤٷµŧ壬²ˡǷŧм˲Ρϵͳ𺦣̷Ⱦһ˥߶Σ
(3)ؽм¹ؽ ؽмм⣬ʪԹؽ֢״ٴйؽ״ʹޣؽڻҺΡԺ󣬹ؽڿǿֱX߼ʪԹؽ׸ı䣬ʪӼԡеĻѪ죬ɰзȵȫ֢״ؽڲмԣ¶
(4)Ƥмȫ𺦼̷Ⱦ ƤмټءΪƤԳ򰵺죬ͻ渲дƤм߰ͷʹȡηȫʣdzܰͽ״󣬰ϸߡûмʱȷƤϸ룬ᵼ°Ѫ֢ѪҺճߡѪȣ˥߶ڸΡ˥߶
мۣӰ쵽壬˻߲ɵģòǡҩƣɸΣ

Ԥ

һԤȾֲȾշţƤѢһҪԭǸð󣬁㷢סףҪƣ̲̣巴ףмйϵߣɿDZгһ껼ΪҪ

 أţƤѢҪշԭ֮һ ʳҩӴijʶշţƤѢķÿθ ϸʲôӴijʣӶʹƤ̶ֺߣôʣ ӦӴ磬ijЩƷţ⡢Pʵȡ
 
ܷܳ纮ϮշţƤѢΪ϶࣬ ھסʪ䣬ʹأ ˻Ӧȴ̼Ƥסұͨ
 
ġأճڹѹϢã Ƚţȶ˼ŭֲܺĵʳûйɣʳʳȷ֮ȣԼԭðȡ巢ף߹ܵ£ȱֿӶţƤѢ͸ȵľţ鼱ȾΪռ֮ףҹԼռţƤѢܷʵ18.6% ȽţɲһϵӦʹڷң𺦻߷ϵͳijЩøĴлңӶٽţƤѢķвɿܵĻ޷Ԥ֪ͻ飬Ӧƽ飬֤˯ʱ䣬Ҫʱɷ򾲼
 
塢пҩ״ѡʲôҩţƤѢЧǷ񸴷ؼáһʱڣҽѧоţƤѢķϣ൱̶߽ҪڣţƤѢϸտʼԺʱʱ˵߻͡ڷڹҡ΢ѭʧʹƤйϰʹӦйڶػƤ¡õҩﲻָƤлܡйڶأüءƼߡƤйܣԽԽأɲ̺ΡôΪһӦöҩиʶĿǰڿţƤѢҩƤʼࡢȡ ƤʼࣺҪáڷ֡ҩõзɡƤַҺ˪ʿ󣩵ȡڷǿɡɼһЩڵĸŨȼɣ𣩵ȡƤʼؿмȻЧ졢ʹ÷㣬úܴʹ߶ڷ֣ɤ֣ë賤ɣۡΪ֢ţƤѢҪ򣬹ʶһ㻼߲üأʹʱҲֻûҽָʹãʹֲƤήͻȻͣҩصķʹӶ񻯡

֮ţƤѢշԭֻܶ࣬лճжע⣬ע⻷շɾơϺζ⼰ȷ֮ð巢ףҪҽƲƣЩҩȵȣܼٸᡣ

ĿǰƷֻܴﵽЧֹ

1.һƷ  ˵ģȶշءƸȾʳƣڲ˽ô̼Խǿҩ

2.ȫ  κͷмӦȫΪȫƵԭҪѡøСڳҩҩڼ䶨ڹ۲ΡܼѪı仯

1ʣMTX  ΪҶ࿹ҩDZȽмϸҩԸмЧڹؽ͡Ƥ͡ŧмѰмƷЧ߿ѡðʡҪϸDNAϳɣֹDNAϸ˿ѡҩһĿǰһΪ15mg/ܣΪ50mg/ܡɲÿڷעҩķҩԸĶԷӦءĹ㷺ά͸ӲѪϵͳãҪְϸ½ѪСӰ죬ʱȫѪ½ҩڼ䶨ڸιܺѪ棬ҪϸѡӦ֢ԸϰƶѪϸͼ︾Ůôҩ

2ǰ  ֳǰ154˫ͪມҪϸǺĺϳɣӶϸá÷һÿ300400mg23οڷһҩ34ܺЧЧ58%88%Ҫǹƣɰϸ½ѪС½бʹñҩѪı棬ʹøҩʱڸѪ档ΪϸٵĸãԸδѪϸҩҩȱͣҩ׸Ϊ⸴ɲƤ˺Сϳʱάַÿ˫ͪ຿ɼ100mg100mgɴ׼١˫ͪͣҩ󸴷˫ͪຳϳӦЧüȳҪ

3ǻ  мŧмп϶Чܼȫŧмŧ壬Ⱥж֢״ҪDNAĺϳɣΪÿ0.5gÿ23Σ48ΪһƳ̡ԷӦҪǰϸѪСļ٣ԸĶԽС

4Acyclosporin A. CyAΪһƼ1979Mueller״αصмЧԺCyAԽԽ㷺ƸмҩмĻвȫĿǰӦCyAмı÷CyAʼΪ5mg/(kg · d)οڷЧ𽥼ӦθӦ·̼ѪѹߵȡCyAǿģͣҩ׸ĿǰоθʹCyAмҪƤ߿ע估CyA۸񰺹󣬲˹㷺ƹʹáɽSandimmun Neoralһ͵ĻA΢黯ԺƤͣŧͣؽ͵ммõƺͻá

2Ƥ̴  Ƥ̴ƸмнϺõЧĿǰһ㲻ôҩΪӦüϴʱϳؼظáڼͣҩصмΪŧмƤмճ־ö޷Ʋʱŧмɲʹ֢״ҩʱԹؽм𺦹ؽʱԿӦƤ̴ƼһӦǿÿ60mg൱Ƽע۲켤صĸá

1άC  ÿվעάC 3gһΪһƳ̡ΪάCƤcAMPˮƽƱƤϸֳá

2ά  һϵάAзάᣬŧмкܺõЧüΪ0.51mg/kgҪΪ»͸𺦣举Ů͸ιܲȫ߽á

4  ٴмӦÿյЧ˫Чù80Uע䣬ÿ1Σ15ΪһƳ̣ùسÿ0.750.9g5%ҺоΣÿ1Σ15졫30ΪһƳ̡гҽԺúùأùأùأȷصȾѰмյЧùŧмãڷÿ0.250.5gÿ3λע0.4gÿ2Ρ

5ߵڼ  ߹ܵµм߿ߵڼDעҺÿ10mgעһ丱΢Ҳ150mg/dÿܷҩ3죬ͣҩ4죬һҩ13£ҲתӡһЧ

6ҽҩ  ҽѧƱΪ“ׯH”ҽΪмҪΪѪȶʢѪҽƱķЧ࣬гҽԺƤƣݱIJֱȷѪٷѪб֤Ρ

ȷѪм൱ڽڣѪΪءԪΡ֡éţӡ֪ĸ桢硢顢ʲݵȡø÷м98Ч84.7%ø÷ˮŨжԱƤϸͰϸ6ӰʵоҩֱƽϸֳIL-6IJӶ֤÷мЧĻ

ѪѪм൱ھֹڣԻѪΪߡ⡢ݭ컨֡βʲݡ

ѪѪм൱ھֹڣǨվáء䷿顢ڡ֡춬󶬡񡢸ʲݡ

⻹ҩƼܺעҺơ紨ܺ200mg5%ҺоΣÿ1Σ30ΪһƳ̡20mL5%ҺоΣÿ1Σ30ΪһƳ̣һЧ

3.ҩ  ԾԵƤѡҩƣԭΪʰѼϸƼΪڽڲô̼ǿҩշƤ֢

1֣anthralin ƱƤϸмһЧٴ0.1%1%࣬ҪǶƤд̼ԣӦλƤƼʹƤڣȾ·

2Ƥ̴  ɿϸ˿áٴõзɣȷ˪мнϺõĽЧҪ糤ھֲÿƤήëëϸѪŵȡ

3Ʋcalcipotriol  άD2ԴлǻΪ1991״мҩҩԽϸֻǿĵáƲ50μg/gȻжмЧͰȫġ

4ȼ˪  ʣMTXмЧ϶ô󡣹Ź0.1%˪м54ͬʱѪMTXŨȼ⣬Ч83.3%ѪδMTXδȫá0.1%˪мЧ

4.Ʒ  ɸݲʵѡÿȪԡҩԡϴԡƷ⻯ƷȾѡá

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