| ObjectiveThe purpose of this study was to explore The value of PCT、WBC、CRP、ESR and other indicators in the diagnosis of generalized pustular psoriasis and erythrodermic psoriasis fever with bacterial infection,and to compare the hematological indexes of GPP patients with different TCM syndromes to provide possible objective basis for TCM syndrome differentiation.MethodThe study used a single-center、retrospective studyof 89 GPP and EP patients who were hospitalized in the dermatology department of wuhan first hospital from january 2018 to september 2019.1.Clinical data of GPP and EP patients included hospitalization number,sex,age,diagnosis,previous history of psoriasis,cause of onset,fever,highest body temperature,local lesions,redness,swelling,heat,lymph node enlargement,tonsil enlargement and secretion,etiological examination(including specimens from blood,sputum,pus,alveolar lavage fluid,stool,urine or other cultures),chest X line/tuberculosis antibody,virus antibody,WBC、NEU、LYM、NLR、PLT、PCT、ESR、CRP、TCM syndrome type,treatment plan and prognosis of disease.2.According to whether there is fever or not,89 patients were divided into fever group and non-fever group,and according to the degree of fever,the fever group was further divided into low-medium heat group and high fever group;according to the type of infection,89 patients were divided into bacterial infection group,suspected bacterial infection group,non-infection group and mycoplasma,fungi,tuberculosis and other infection groups;according to the syndrome type of traditional Chinese medicine,the GPP patients were divided into toxic heat incandescent group,yin deficiency blood heat group,yin deficiency blood stasis group.3.Compare the differences between WBC、NEU、NLR、PLT、PCT、ESR、CRP groups according to different groups;person correlation analysis was used to analyze the correlation between WBC、NEU、PCT 、 CRP in the bacterial infection group;binary Logistic regression analysis was used to analyze the influencing factors of GPP and EP fever patients complicated with bacterial infection;subject work characteristics(ROC)curve was used to evaluate the diagnostic value of individual and combined levels for GPP and EP fever patients complicated with bacterial infection.ResultGeneral data :(1)There were GPP 29 and EP 60 cases in 89 patients.Among them,58 cases were fever patients,including 31 cases of bacterial infection(including 1 case of adrenocortical dysfunction),16 cases of non-infection,7 cases of suspected bacterial infection(2 cases of adrenocortical dysfunction),3cases of mycoplasma pneumoniae infection and 1 case of systemic fungal infection;31 cases of non-fever patients,including 30 cases of non-infection(including 1 case of adrenocortical dysfunction)and 1 case of tuberculosis infection.(2)Inducement :43 of the 89 GPP、EP patients in this study found definite inducements,including 12 cases of irregular immunosuppressant reduction,12 cases of upper respiratory tract infection,8 cases of systemic/external use of unknown drugs,2cases of sudden withdrawal of large area external hormone,2 cases of fatigue and 7 cases of other causes(systemic oral hormone 1 case,taking "honeysuckle dew " 1 case,no regular treatment 1 case,drug allergy 1 case,menstruation 1 case,external washing of traditional chinese medicine 1 case,use of placental hormone 1case).Among them,immunosuppressant reduction irregular,upper respiratory tract infection,system / external use of unknown drugs as the main inducement.(3)Sex: There were 64 males and 25 females in 89 GPP and EP patients.The ratio of males to females was 2.56:1.Among them,fever group male 42 cases,female 16 cases,non-heat group male 22 cases,female 9 cases.Among the fever patients,there were 24 cases of male and 7 cases of female in bacterial infection group,8 cases of male and 8 cases of female in non-infection group.(4)Age :89 GPP and EP patients aged 5-81,mean(48.28±1.5)years.Among them,the fever group was 5-81 years old,with an average age(44.97±20.73)years;the fever group was 26-81 years old,with an average age(54.84±12.84)years.Among fever patients,the bacterial infection group was 11-68 years old,with an average age(43.23±18.15)years;the non-infection group was 6-81 years old,with an average age(46.56±22.51)years.Of the 89 GPP and EP patients,5 were aged younger than 12 years old,accounting for5.62% of all patients;There were 4 cases older than 12 years old and younger than 18 years old,accounting for 4.49% of all patients;17 cases older than 18 years old and younger than 40 years old,accounting for 19.10% of all patients;37 cases older than 40 years old and younger than 60 years old,accounting for 41.57% of all patients;and 26 cases older than 60 years old,accounting for29.21% of all patients.Among them,the proportion of the age group in the 40-60 age group is the highest,for the GPP、EP prone age group.2.Parameter comparison between groups:(1)Parameters comparison between fever group and non-heating group: the WBC、NEU、NLR、PLT、ESR、PCT、CRP of fever group was higher than that of non-heating group,and the difference was statistically significant(p<0.05).(2)Comparison of bacterial infection group in fever patients and non-infection group in non-heating group(excluding patients with adrenocortical dysfunction):The WBC、NEU、NLR、ESR、PCT、CRP in the bacterial infection group was higher than that in the non-infection group(p<0.05),but there was no significant difference in PLT between the two groups(p>0.05).(3)Comparison of bacterial infection group and non-infection group in fever patients(excluding patients with adrenocortical dysfunction):The WBC、NEU、PCT、CRP of bacterial infection group was higher than that of non-infection group(p<0.05),but there was no significant difference in NLR、PLT、ESR between the two groups(p>0.05).(4)Comparison of parameters between the low and middle heat group and the high heat group in the non-infection group in fever patients: the NEU、NLR、PCT of the low and middle heat group was lower than that of the high heat group,and the difference was statistically significant(p<0.05),but the WBC、PLT、ESR、CRP difference was between the two groups difference was not statistically significant(p>0.05).(5)The parameters of GPP toxin,heat and heat group,Yin deficiency and blood stasis group were compared: WBC、NEU、NLR、ESR had statistical significance among different TCM syndromes(p<0.05),as follows:NEU 、 NLR in Yin deficiency and blood heat group and Yin deficiency and blood stasis group were lower than those in poison heat incandescent group(p<0.05),but there was no significant difference between them in Yin deficiency blood heat group and Yin deficiency blood stasis group(P>0.05).The WBC of Yin deficiency and blood stasis group was lower than that of poison heat incandescent group(p<0.05),but the WBC of Yin deficiency and blood heat group was not statistically significant(P>0.05).Compared with Yin-deficiency and Blood-stasis group,the ESR of Yin-deficiency and Yin-deficiency and Blood-heat group were both high The difference was statistically significant in Yin deficiency and blood stasis group(p<0.05),but there was no significant difference in ESR between Yin deficiency and blood heat group.PLT、PCT、CRP had no significant difference between different TCM syndromes(P>0.05).3.Correlation analysis between WBC、 NEU、CRP and PCT in bacterial infection group:there was a significant correlation between WBC and NEU(r=0.98,P<0.05),and both them had correlations with CRP(r=0.579,P<0.05;r=0.621,P<0.05),while the correlation with PCT was not high(r=0.275,P>0.05;r=0.245,P>0.05).there was a correlation between PCT and CRP(r=0.609,P<0.05).4.GPP analysis of variables associated with bacterial infection in patients with EP fever: WBC、NEU、PCT、CRP was included in binary Logistic regression analysis to correlate variables with bacterial infection in patients with fever.The results showed that PCT、WBC was associated with bacterial infection in GPP、EP fever patients(OR=1.01 P=0.06;OR=2.87 P=0.07).5.PCT、WBC and other indicators to GPP、EP fever patients with bacterial infection diagnostic efficacy: PCT and WBC to GPP、EP fever patients with bacterial infection have certain test efficacy:when the PCT was diagnosed alone,the area under the ROC curve was 0.767 and the optimal cut-off value was 0.035 ng/m L,and the sensitivity and specificity were 0.800 and 0.687,respectively;when the PCT was 0.155 ng/m L,the sensitivity and specificity were0.458 and 0.800,respectively;when WBC was diagnosed alone,the area under the ROC curve was 0.703,the best cut-off value was 10.315×109/L,the sensitivity and specificity were 0.733 and 0.625,respectively.The test efficiency of the combined WBC was enhanced compared with both,and the area under the ROC curve was 0.809,when the cut-off value of the combined factor was 0.48,the sensitivity and specificity reached 0.900 and 0.687,respectively.ConclusionThe results of this study show that the prevalence of GPP and EP is higher in men than in women,and the hair age of GPP and EP distribution in 40-60 years old.PCT、WBC can be used as an early diagnostic index for GPP and EP fever patients with bacterial infection,combined detection can improve the sensitivity and specificity of diagnosis.NEU、NLR、PCT is related to the degree of GPP、EP fever,which has certain reference value in judging the severity of GPP、EP disease.NEU、NLR has reference significance in differentiating GPP toxin-heat-sense type from non-toxic-heat-sense type(yin-deficiency-blood-heat type,yin-deficiency-blood-blood-stasis type);ESR has reference significance in differentiating GPP yin deficiency and blood stasis type from non-yin deficiency and blood stasis type(poison heat incandescent type,yin deficiency and blood heat type).GPP and EP fever causes complex,clinical need to carefully search for pathogens,immunosuppressive and anti-infection treatment resistance patients should pay attention to the examination of adrenal cortex function. |
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