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Characteristics and Associated Factors of Autoimmune Diseases-related Skin Ulcer: A Multi Center Study
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摘要: 目的 探索自身免疫性疾病相关皮肤溃疡评分水平及相关因素，为临床医务人员有针对性开展干预措施和管理方案提供思路借鉴。方法 从2022年12月至2024年2月，收集来自国内不同地区的10家医院自身免疫性疾病患者皮肤溃疡相关资料。数据包括患者Fitzpatrick皮肤类型、既往晒伤情况、自理能力、皮肤溃疡发生时间、皮肤溃疡评分、皮肤溃疡发生部位，皮肤溃疡Bates-Jensen伤口评估量表（ Bates-Jensen wound assessment tool，BWAT）评分、疼痛视觉模拟评分（ visual analogue scale，VAS）。不同特征患者皮肤溃疡评分采用方差分析或t检验，皮肤溃疡评分的相关因素采用多因素线性回归分析。结果 共收集304例患者的临床数据，其皮肤溃疡BWAT平均得分为（ 32.0±8.6）分。原发疾病类型最常见为皮肌炎（ 28.9%）。皮肤溃疡多发生于足部（ 22.0%），皮肤溃疡疼痛VAS平均分为（ 4.5±1.9）分。多因素线性回归分析显示，患者来自地区（ β=0.143）、VAS评分（ β=0.162）、皮肤溃疡所在部位（ β=0.168）、雷诺现象是否存在（ β=0.120）、抗生素使用情况（ β=1.206）和糖皮质激素使用情况（ β=1.189）是影响皮肤溃疡评分的风险因素。结论 皮肤溃疡的严重程度与疾病类型无关，来自经济欠发达和相对寒冷气候地区的患者皮肤溃疡状况较差；患者的健康教育应通俗易懂，强调坚持规律服药从而控制原发病进展的重要性，加强对溃疡部位皮肤变化、疼痛情况的自我观察；可根据TIME临床决策支持工具构建多学科协作性皮肤溃疡管理计划及TIME伤口管理原则对溃疡局部进行管理。Abstract: Objective To explore the scoring level and related factors of autoimmune disease-related skin ulcers by collecting data from multiple centers, and to provide ideas and references for targeted intervention measures and management plans for clinical medical and nursing staff. Method From December 2022 to February 2024, data related to skin ulcers in patients with autoimmune diseases from 10 hospitals in different regions of China were collected. The data includes the patient's Fitzpatrick skin type, previous sunburn history, self-care ability, time of skin ulcer occurrence, skin ulcer score, location of skin ulcer occurrence, Bates Jensen wound score (BWAT) for skin ulcer, and VAS score for skin ulcer pain. The scores of skin ulcers in patients with different characteristics were analyzed using analysis of variance or t-test, and the related factors of skin ulcer scores were analyzed using multiple linear regression. Results Data from 304 patients were collected, with an average BWAT score of 32.0 ±8.6 for skin ulcers. The most common type of primary disease is dermatomyositis (28.9%). Skin ulcers mostly occur in the feet (22.0%), and the average VAS score for skin ulcer pain is (4.5 ±1.9) points. Multivariate linear regression analysis showed that the patient's region of origin (β=0.143), VAS score (β=0.162), wound site (β=0.168), presence of Raynaud's phenomenon (β=0.120), antibiotic use (β=1.206), and the use of glucocorticoids (β=1.189) were statistically significant factors affecting skin ulcer scores. Conclusion The severity of skin ulcers is not related to the type of disease, and patients from economically underdeveloped and relatively cold climates have poorer skin ulcer conditions. Health education for patients should be easy to understand, emphasizing the importance of adhering to regular medication to control the progression of the primary disease, and strengthening self observation of skin changes and pain at the ulcer site. A multidisciplinary collaborative skin ulcer management plan can be constructed based on the latest TIME clinical decision support tool (TIME-CDST), as well as TIME wound management principles for managing the ulcer site.
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Keywords:
- autoimmune diseases /
- skin ulcer /
- multi center /
- chronic wounds /
- nursing
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