临床特征和皮肤CT特征判定白癜风分期  

Vitiligo staging based on clinical and skin computed tomography features

作　　者：刘涛[1] 许爱娥[2] 

机构地区：[1]安徽医科大学附属杭州临床学院,杭州310009 [2]杭州市第三人民医院皮肤科

出　　处：《中华皮肤科杂志》2015年第6期404-407,共4页Chinese Journal of Dermatology

基　　金：国家自然科学基金（81071294、81271758）;浙江省自然科学基金（Z2100973）;省部共建项目基金（WKJ2012-2-036）;杭州重大科技创新项目（20122513A02）

摘　　要：目的 采用临床特征和皮肤CT特征来判定白癜风分期.方法 200例白癜风患者按照临床特征问卷和皮肤CT特征进行分期：＞2分为快速进展期,1～2分为缓慢进展期,＜1分为稳定期.选择进展期和稳定期白癜风患者各5例,在皮肤CT检测的区域进行HE染色分析.结果 用临床特征和皮肤CT特征判定200例白癜风患者的分期,差异无统计学意义.临床特征：进展期为白斑边缘隆起或与周围正常皮肤边界不清,三色白癜风,皮损颜色呈灰白色或浅白色;稳定期为白斑区与正常皮肤边界清晰,皮损颜色呈乳白色或瓷白色,可见色素岛.皮肤CT：进展期为表真皮交界处色素环失去完整性,与周边正常皮肤边界不清,在表真皮交界、边缘处可以看到高折光性细胞.稳定期为表真皮交界处色素环完全缺失,与周边正常皮肤边界清,有树突状高折射光的黑素细胞存在.HE染色结果显示,进展期在真皮乳头层内的病灶的边缘可见大量的CD8T淋巴细胞.稳定期在真皮乳头层内的病灶边缘未见CD8T淋巴细胞.结论 临床特征和皮肤CT特征可以用来判定白癜风的分期,结果与进展期组织病理学基本一致.Objective To determine the stage of vitiligo according to clinical and skin computed tomography （CT） features.Methods The stage of vitiligo was determined in 200 patients according to a questionnaire-based analysis of clinical features and skin CT findings respectively.Rapid progressive stage was defined as the score for vitiligous lesions or CT findings being higher than 2,slow progressive stage as the score varying from 1 to 2,and stable stage as the score less than 1.Skin samples were obtained at lesional sites receiving CT examination from 5 patients with progressive and 5 patients with stable vitiligo,and subjected to hematoxylin-eosin （HE） staining.Results No significant difference was observed between staging results based on clinical features and skin CT findings.The patients diagnosed with progressive vitiligo based on clinical features presented with grey-white or pale white patches with elevated or obscure boundaries,or trichrome vitiligo,while those with stable vitiligo presented with milky-white or porcelain-white lesions with sharp boundaries and pigmented islands.As CT showed,progressive vitiligo was characterized by a loss of integrity in dermal papillary rings at the dermo-epidermal junction level,obscure boundaries between vitiligo lesions and surrounding normal skin,presence of highly refractive cells at the dermo-epidermal junction level in the margins of vitiligo lesions,while stable vitiligo characterized by complete absence of dermal papillary rings at the dermo-epidermal junction level,sharp boundaries between the lesions and surrounding normal skin,and presence of highly refractive dendritic melanocytes.HE staining showed plenty of CD8 ＋ T lymphocytes in the papillary dermis in the margins of progressive vitiligo lesions,but no CD8＋ T lymphocyte was seen in those of stable vitiligo lesions.Conclusions Both clinical and skin CT features can be used to determine the stage of vitiligo,and the staging results are consistent with those based on histopathological findings.

关 键 词：白癜风 显微镜检查 共焦 病理学 临床 分期 疾病特征 

分 类 号：R758.41[医药卫生—皮肤病学与性病学]