六例对称性肢端角化病的透射电镜观察  

Ultrahistopathological features of six cases of symmetrical acrokeratoderma under transmission electron microscope

作　　者：王思捷 吴亚运 黎世杰 黎兆军 张国学 樊翌明 

机构地区：[1]广东医科大学附属医院皮肤科,广东湛江524001 [2]广东医科大学附属医院电镜室,广东湛江524001

出　　处：《中华皮肤科杂志》2018年第2期131-135,共5页Chinese Journal of Dermatology

基　　金：广东湛江市科技攻关计划项目（2012C3104029）;广东医学院科技创新基金（STIF201103）

摘　　要：目的 探讨对称性肢端角化病的超微组织病理特点。方法 收集广东医科大学附属医院皮肤科6例对称性肢端角化病皮损及其周围外观正常皮肤、3例正常人皮肤活检标本，做透射电镜观察。结果 皮损中角质层明显增厚，角化细胞形态不规则，角化包膜不连续；表皮各层角蛋白细丝聚集和排列异常；角质层与颗粒层移行区可见较多大小不等的空泡；颗粒层变薄，透明角质颗粒形态及大小异常，被膜颗粒减少；基底层黑素细胞增多，胞质中有大量Ⅳ期黑素小体；真皮浅层中少数淋巴细胞浸润。皮损周围外观正常皮肤亦有类似超微结构变化，但程度较轻。结论 该病皮损中可能存在角蛋白、表皮分化复合体蛋白及脂质代谢异常，从而导致表皮增厚及屏障功能受损。Objective To investigate ultrahistopathological features of symmetrical acrokeratoderma. Methods Biopsy specimens were obtained from skin lesions and perilesional normal-appearing skin of 6 patients with symmetrical acrokeratoderma, as well as from normal skin of 3 healthy volunteers. Then, these skin specimens were subjected to transmission electron microscopy （TEM）. Results TEM showed obviously thickened stratum corneum, irregular morphology of keratinocytes and discontinuous cornified envelope. Aggregation and abnormal arrangement of keratin filaments occurred in all epidermal layers. Many vacuoles of different sizes were observed in the transitional zone between the stratum corneum and stratum granulosum. Hypogranulosis, abnormal shape and different sizes of keratohyalin granules, and reduction of membrane-coating granules were found in the stratum granulosum. Increased melanocytes with a large number of stage Ⅳ melanosomes in the cytoplasm were observed in the basal layers. Moreover, there was infiltration of a few lymphocytes in the superficial dermis. Perilesional normal-appearing skin tissues showed similar but milder ultrastructural changes. Conclusion Abnormal metabolism of keratins, epidermal differentiation complex proteins and lipids may exist in skin lesions of symmetrical acrokeratoderma, which may contribute to epidermal thickening and impairment of skin barrier function.

关 键 词：显微镜检查 电子 透射 对称性肢端角化病 角蛋白细丝 透明角质颗粒 被膜颗粒 

分 类 号：R758.5[医药卫生—皮肤病学与性病学]