综合性医院皮肤科门诊麻风78例临床与病理分析  

Clinico-Histopathological Analysis of 78 Out Patients with Leprosy at Department of Dermatology at A General Hospital

作　　者：李凌佳[1] 张胜[2] 刘彤云[1] 谢玉燕[1] 柴燕杰[1] 董天祥[1] 

机构地区：[1]昆明医科大学第一附属医院皮肤科,云南昆明650032 [2]昆明医科大学附属延安医院检验科,云南昆明650051

出　　处：《中国皮肤性病学杂志》2017年第5期514-516,共3页The Chinese Journal of Dermatovenereology

摘　　要：目的了解麻风临床表现和组织病理特点,提高皮肤科医师麻风确诊率。方法回顾性分析2008年1月-2016年7月本科门诊经过组织病理检查而确诊的麻风患者的临床特资料。结果共统计麻风78例,临床表现有局限性浸润、弥漫性浸润、环形至不规则形色素减退性斑片、斑块、结节及溃疡,可伴随眉毛脱落、耳神经和/或尺神经粗大、发热;皮损主要位于面颈、躯干、四肢。临床分型:结核样型20.51%(16/78),界限类偏结核样型2.56%(2/78),中间界限类5.13%(4/78),界限类偏瘤型14.10%(11/78),瘤型17.95%(14/78),未定型麻风1.28%(1/78),临床病理未能分型39.74%(31/78)。病理结果:真皮血管、神经、附属器周围见不同程度的炎性细胞或泡沫样组织细胞浸润;病变累及真皮浅中层53.85%(42/78),其中表皮基底层破坏93.59%(73/78),表皮萎缩、变薄55.13%(43/78),有无浸润带者46.15%(36/78)。抗酸染色:组织切片染色阳性率47.44%(37/78);仅15.38%(12/78)完成组织液涂片染色。结论麻风临床表现多样,组织病理具有特异性改变,联合抗酸染色检查,可大大提高麻风的诊断水平,降低漏诊率和误诊率。Objective To investigate the clinicopathological features of leprosy, in order for dermatologists to improve the diagnosis. Methods Clinical and pathological data were retrospectively analyzed in 78 outpatients with leprosy from January 2008 to July 2016.Results Clinical manifestations of leprosy included circumscribed or diffuse infiltrative hypopigmented macules, plaques and nodules in annular to irregular shapes, and ulceration.Sometimes leprosy was accompanied by loss of eyebrow, thickened ear and/or ulnar nerves, and fever.Lesions mainly located on the face, neck, trunk and limbs.Clinical classification： TT accounted for 20.51%（16/78）, BT 2.56%（2/78）, BB 5.13%（4/78）, BL 14.10%（11/78）, LL 17.95%（14/78）, and in determinate leprosy（I）1.28%（1/78）.39.74% of patients（31/78）couldn＇t be classified based on clinical pathology.Histological features included infiltration of inflammatory or foam cells around blood vessels, nerves and cutaneous appendix.Lesions involved the upper and middle dermis in 53.85%（42/78cases）.Destruction of basal layer presented in 93.59%（73/78）.Epidermal atrophy and grenz zone occurred in 55.13%（43/78）and 46.15%（36/78）, respectively.47.44%（37/78）were positive for Acid-fast staining.Only 15.38%（12/78）completed tissue fluid smears.Conclusion The clinical manifestations of leprosy varied.Specific histopathological features together with Acid-fast staining can dramatically improve the diagnosis of leprosy and reduce misdiagnosis rates.

关 键 词：麻风 临床表现 组织病理学 抗酸染色 误诊 

分 类 号：R755[医药卫生—皮肤病学与性病学]