Objective:To detect serum levels of fibroblast growth factor (FGF) -23 in patients with psoriatic arthritis (PsA), and to explore its correlation with inflammatory markers and disease severity.Methods:A case-control study was carried out. Twenty-five PsA patients and 25 healthy controls were retrospectively enrolled from the First Affiliated Hospital of Xiamen University between January and December 2020. Serum levels of FGF23 and 25-hydroxyvitamin D (25[OH]VitD) were detected in all participants. In PsA patients, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were also measured, and disease activity was assessed using the disease activity index for psoriatic arthritis (DAPSA). Differences in the serum levels of FGF23 and 25 (OH) VitD were analyzed between high CRP (> 3 mg/L) and normal CRP (≤ 3 mg/L) subgroups, between high ESR (> 15 mm/1 h) and normal ESR (≤ 15 mm/1 h) subgroups, as well as between moderate-to-high disease activity (DAPSA > 14 points) and low disease activity (DAPSA ≤ 14 points) subgroups. Correlations of FGF23 with CRP, ESR, DAPSA, and 25 (OH) VitD were analyzed. Statistical analyses were carried out by the two independent samples t-test and Spearman correlation analysis. Results:Serum FGF23 levels were significantly higher in the PsA patients (224.30 ± 25.83 pg/ml) than in the healthy controls (123.80 ± 11.76 pg/ml, t = 3.54, P < 0.05), while no significant difference was observed in serum 25 (OH) VitD levels between the two groups ( P > 0.05). Among the PsA patients, the serum FGF23 levels were significantly higher in the high CRP group than in the normal CRP group, significantly higher in the high ESR group than in the normal ESR group, and significantly higher in the moderate-to-high disease activity group than in the low disease activity group (all P < 0.05) ; however, there were no significant differences in the 25 (OH) VitD levels between these subgroups (all P > 0.05). In the PsA patients, the serum FGF23 levels showed positive correlations with the levels of CRP and ESR, as well as with DAPSA (all P < 0.05), but no significant correlation with serum 25 (OH) VitD levels ( P = 0.914) . Conclusion:Serum FGF23 levels in PsA patients were significantly higher than those in healthy individuals, and were positively correlated with CRP, ESR, and DAPSA.
患者男，74岁。躯干、四肢皮肤反复瘀斑、丘疹、结节伴瘙痒、疼痛6年，加重2周入院。患者6年前无明显诱因左上肢皮肤出现数枚指甲大小紫红色瘀斑和斑丘疹，自觉瘙痒、疼痛，部分可自行消退，但反复发生，并逐渐增多、增大，形成结节及斑块，破溃愈合后形成瘢痕。2周前无诱因病情加重，足部出现大片瘀斑、血疱、破溃伴明显疼痛，当地医院诊断为"多形红斑"，给予对症治疗，病情无缓解，故就诊于我院。既往体健，否认遗传病及食物、药物过敏史。
患者男，68岁，因头部红斑、丘疹7个月，近日加重就诊。7个月前不明诱因患者头部出现红斑、密集性丘疹，逐渐发展至颈部、耳廓、口腔、前胸V区、肩部、双手背，外院诊断为多形性日光疹、皮肌炎，并予复方甘草酸苷片、依巴斯汀片、糠酸莫米松乳膏等治疗，疗效欠佳。10 d前出现全身对称性多关节肿痛，伴咳嗽、咳痰。无发热、肌无力、肌痛、口腔溃疡、脱发、吞咽困难、呼吸困难等。既往无其他病史，家族中无类似疾病者。系统查体未见异常，四肢肌力V级。皮肤科检查（图1A）：双侧眼睑见水肿性紫红斑；面颈部、前胸V区、肩部可见片状红斑、毛细血管扩张及色素沉着；头皮、耳廓、颈部、双手背见红斑及密集、坚实的丘疹、结节；双侧手指、腕、肘、肩、膝、踝关节水肿、压痛，可见杵状指/趾，双手不能握拳，双足趾可见甲周红斑；下齿龈可见数个淡红色丘疹，会阴黏膜无明显皮疹。实验室及辅助检查：白细胞10.7 × 10 9/L（参考值：3.5 × 10 9/L ~ 9.3 × 10 9/L，下同），中性粒细胞7.47 × 10 9/L（1.8 × 10 9/L ~ 6.3 × 10 9/L）；肿瘤标志物：糖类抗原19-9为3.9 ng/ml（≤ 3.3 ng/ml），癌抗原12-5为55.9 U/ml（≤ 24 ng/ml）；免疫全套：抗核抗体1∶1 000（胞质型、核仁型、核点型），RO-52抗体> 400 RU/ml（0 ~ 20 RU/ml），SSB抗体26.87 RU/ml（0 ~ 20 RU/ml）；抗肌炎抗体谱：抗EJ IgG抗体和抗SSA/RO-52 IgG抗体均阳性；C反应蛋白52.3 mg/L（0 ~ 10 mg/L）；红细胞沉降率20.9 mm/1 h（0 ~ 15 mm/1 h）；便尿常规、肝肾功能、总IgE、抗环瓜氨酸肽抗体、链球菌溶血素O抗体、类风湿因子、肌酶谱、心肌损伤标志物、凝血功能检查未见异常。心脏彩超：主动脉窦部、升主动脉增宽，三尖瓣轻度反流，肺动脉轻度高压。肩关节、手关节X线片检查示肩、手关节无骨质异常。胃镜：食管黏膜隆起，起源于固有肌层，考虑食管平滑肌瘤可能。胸部高分辨CT：双肺间质性肺炎，肺气肿，双肺散在纤维灶，散在增殖小结节，肺门增大，纵膈淋巴结增大，双侧胸膜增厚。左颈部皮损组织病理（图2）：表皮轻度角化过度，基底细胞液化变性，真皮浅层嗜碱性改变，大量组织细胞浸润，细胞体积较大，可见多核巨细胞，胞质嗜酸，呈毛玻璃样，核分裂象活跃。左颈部皮损免疫组化：CD163和CD68阳性，CD1α、CD45、CD117、CD207、S100、广谱细胞角蛋白、黑素瘤标志物阴性。过碘酸希夫染色（PAS）阳性，抗酸染色阴性。
Actinic keratosis is a precancerous skin lesion caused by long-term sun exposure, and may progress to cutaneous squamous cell carcinoma. Bowen disease is a squamous cell carcinoma in situ of the epidermis. Differential diagnosis of actinic keratosis, Bowen disease and cutaneous squamous cell carcinoma, as well as early diagnosis of cutaneous squamous cell carcinoma, has always been research hotspots. This review summarizes biomarkers related to the malignant progression of actinic keratosis, with a view to providing a reference for early clinical diagnosis.
Objective:To evaluate the clinical efficacy and safety of dupilumab in the treatment of endogenous hyperkeratotic hand-foot eczema.Methods:Five patients with endogenous hyperkeratotic hand-foot eczema who showed inadequate response to conventional therapies were included in this case-series study and treated with dupilumab. Baseline scores before treatment were used as controls. During follow-up, treatment efficacy was quantitatively evaluated using the Hand Eczema Severity Index (HECSI), and adverse events were recorded.Results:Five patients with endogenous hyperkeratotic hand-foot eczema were included, aged 41 - 68 years, including 2 males and 3 females, with a disease duration ranging from 6 months to 40 years. For hand lesions, all five patients achieved HECSI50 at week 2, HECSI75 at week 12, and HECSI90 at week 20. For foot lesions, 4 patients achieved HECSI50 at week 4, and 4 patients achieved HECSI75 and HECSI90 at week 12.Conclusion:Dupilumab could rapidly improve skin lesions in patients with endogenous hyperkeratotic hand-foot eczema who had an inadequate response to conventional therapies, with a favorable safety profile.
