The Analysis Of Clinical Feature,Quality Of Life And The Level Of Plasma Lipoprotein (a)in Patients With Livedoid Vasculopathy

Livedoid vasculopathy is a kind of skin disease caused by local vascular occlusion.It mainly manifests as erythematous and purpuric macules or papules on the legs and ankles,which may progress into intensely painful ulcers and heal leaving porcelain-white atrophic scars with angiotelectasis and hyperpigmentation.The pathogenesis is still unclear,it is commonly considered to be related to local thrombosis and other autoimmune diseases.This study mainly analyses the clinical manifestation,serologic examination,the quality of life and the level of plasma lipoprotein(a).Part1 Clinical analysis of patients with livedoid vasculopathyObjective To analyze the clinical feature and discuss the regularity of disease developent of LV,further explored the pathogenesis of LV and provide effective evidence to help to make the reasonable therapeutic method in the clinic.Methods Clinical data of 32 patients with LV from our clinic in 2016 were collected,made a retrospective analysis about their clinical manifestation and serologic examination.Results 18 male and 14 female were rolled in this study,the ratio was 1.3:1.The mean age of these patients were(25.19±13.54)years,the average onset age is(19.97± 11.93)years.There are 7 patients had lesion on both feet,25 patients involved shank in different degree and 1 patient with angiotelectasis on her thigh.All patients manifested porcelain-white atrophic scars and hyperpigmentation.3 patients had no ulcers,other 29 patients all manifested different size of ulcers.In these 32 patients,11 patients accompanied angiotelectasis and 8 patients had purpura.26 patients had painful lesion,two of them felt pruritus at the same time.There are 30 patients became aggravated in summer and got remission in autumn or winter.Other two patients did not have the seasonal characteristic.4 patients got worse after activities or standing.In this group,there are 5 patients had high level of ?2GP1,1 patient had high level of ACA.3 patients were positive with ANA.1 patient had lower C3.1 patient was positive with RO/ssA52.Conclusion These patients in the group manifest various autoimmune antibody,shows that autoimmune mechanism plays a role in the pathogenesis of the disease.The age of this group is younger than before,these patients have no evidence on varicose vein of lower limb and autoimmune disease,so they should be classified into idiopathic LV.They maybe have some gene defect that lead to partial thrombosis.It also provides a good thought and direction for our research in the future.Part 2 Assessment of quality of life in patients with livedoid vasculopathyObjective To evaluate the influence of livedoid vasculopathy on the quality of life in patients by the DLQI,in order to evaluate the patient's condition and help to make clinical treatment strategies.Methods The DLQI was used to evaluated the quality of patients with livedoid vasculopathy.The reliability and factor structure of the DLQI was evaluated by reliabilityanalysis and factor analysis.Results Twenty-two patients(13 males and 9 females)were asked to complete the DLQI.The mean age was 33±3.07 years with a mean clinical course of 5.93±1.05.The DLQI score,which varied from 1 to 16 with an average of 6.64±0.86.Patients with LV had the greatest impact on "leisure and entertainment",followed by "treatment","symptoms and feeling",otherwise,interpersonal relationship of the patients had no influence.The scores of females were higher than males in total score,and the score of"symptoms and feeling" and "daily life" were higher in females than those in males(P<0.05).The score of "symptoms and feeling" showed negative relation with the patients'age.Reliability analysis showed that F=52.66(P<0.05),In Hotelling'S T-Squared test,F=348.779(P<0.05),Cronbach's Alpha is 0.759.There were no excluding items.Correlation coefficient ranged from 0.202 to 0.721 in items(P<0.05).DLQI had high reliability and validity.Conclusion LV has a moderate impact on the quality of life in patients,while it has a bigger impact on females than males.There is negative correlation between the age of patients and the quality of life in "symptoms and feeling".DLQI can be applied to the evaluation of quality of life in patients with LV with a high reliability and validity.The score can assess disease and help to make clinical treatment strategies.in some degree.Part 3 Research on the relationship between plasma lipoprotein(a)concentration and livedoid vasculopathyObjective Measured the plasma lipoprotein(a)of patients with livedoid vasculopathy and healthy control people,and discovered the relationship between patients' plasma lipoprotein(a)and the pathogenesis of livedoid vasculopathy;Methods Measured the level of plasma lipoprotein(a)of 44 patients with livedoid vasculopathy from 2013-2016 and 44 healthy people by immunoturbidimetry.Results 44 patients and 44 healthy people,their gender and ages had no significant statistic difference(P>0.05).The average concentration of experiment group was(18.18±20.50)while the control group was(12.97±16.20)mg/dl,t=0.189(P>0.05).There was no significant statistic difference between these two groups.The plasma lipoprotein(a)concentration in six cases(13.64%)were over 30mg/dl in control group while there were twelve cases(27.27%)in experiment group.Pearson chi-square test ?2?2.514(P>0.05).It was no significant statistic difference between the two groups.Conclusion There is no statistic difference in the level of plasma lipoprotein(a)between patients and control.So the high level of plasma lipoprotein(a)cannot be a specific maker to diagnosis LV.But it is still possible playing a role in the pathogenesis of disease.The pathogenesis of the disease should be further explored.