砷角化病患者皮肤临床表现及病理分析并文献复习  

Patients With Arsenical Keratosis: Clinical Manifestations and Clinicopathological Analysis and Literature Review

作　　者：刘勇[1] 纪华安 蒋延英[3] 

机构地区：[1]天津市第三中心医院皮肤科,300170 [2]天津中医药研究院附属医院病理科 [3]天津市第三中心医院病理科,300170

出　　处：《中国全科医学》2016年第6期720-723,共4页Chinese General Practice

摘　　要：目的探讨砷角化病患者的皮肤临床表现、实验室检查、病理学检查特点、治疗及转归。方法收集2010年3月—2015年1月天津市第三中心医院收治的砷角化病患者20例为研究对象,回顾性分析其皮肤临床表现、实验室检查、病理学检查结果、治疗及转归并复习相关文献。结果 20例患者中14例患者出现掌跖角化过度,12例患者躯干四肢出现散在点状、疣状、皮角样、角化斑片样皮损,其中6例出现鲍温病、6例出现鳞状细胞癌、2例出现反复难愈性皮肤溃疡,11例患者出现皮肤疣状增生物,8例患者全身皮肤颜色加深,6例患者指、趾甲变色,部分伴有白色横纹,6例患者出现瘙痒、针刺样疼痛等症状,3例患者出现口腔溃疡,4例患者出现其他系统症状;18例血砷及尿砷水平均升高,3例患者血小板计数(PLT)下降,2例患者血肌酐水平升高;掌跖角化区域皮损病理学检查可出现多样性变化;二巯基丙磺酸钠、阿维A治疗有效,伴发鲍温病及鳞状细胞癌患者行Mohs'显微外科手术治疗,复发率较低。结论砷角化病患者少见且接触途径多样,皮损特点及皮肤临床表现多样化,实验室检查具有特异性,诊断主要依靠病史询问、皮肤临床表现及实验室检查;药物联合手术治疗预后较佳。Objective To investigate the clinical manifestations,laboratory inspection,pathological characteristics,treatment and outcome. Methods Enrolled 20 subjects with arsenical keratosis who were admitted into Tianjin Third Central Hospital from March 2010 to January 2015. A retrospective analysis was made on their clinical manifestations, laboratory examination,pathological characteristic, treatment and outcome. Results Among the 20 patients,14 had hyperkeratosis of palms and soles; 12 had disperse punctiform,verrucous,cutaneous horn alike and keratinized patch skin lesions on four limbs;6 patients had Bowen disease; 6 patients had squamous cell carcinoma; 2 patients had recurrent refractory skin ulcer; 11 patients had verrucous hyperplasia; 8 patients saw skin color deepen all over the body; 6 patients saw the color of their nails change with white cross grain on the nails of several patients; 6 patients had pruritus and needling- like pain; 3 patients had ulceration in oral cavity; 4 patients had symptoms of other body systems; 18 patients had elevated blood arsenic and urine arsenic levels; 3 patients saw blood platelet count decrease; 2 patients had elevated creatinine level; diversified changes were found by histopathological examination; sodium dimercaptosulphonate and acitretin were effective,and patients who were complicated with Bowen disease and squamous- cell carcinoma and underwent Mohs＇ microsurgical treatment had low recurrence rate. Conclusion Patients with arsenical keratosis are rare and causes are various. Patients have diverse skin lesion characteristics and skin clinical symptoms. Laboratory examination had specificity, and the diagnosis mainly relies on consultation of medical history,clinical manifestations and laboratory examination. Prognosis of patients receiving both drug therapy and surgery is better.

关 键 词：砷中毒 皮肤角化病 掌跖 病理状态 体征和症状 

分 类 号：R599.4[医药卫生—内科学]