反射式共聚焦显微镜在丘疹鳞屑性皮肤病诊断中的应用  

Application of Reflectance Confocal Microscopy in the Diagnosis of Skin Diseases Characterized Mainly by Papules and Scales

作　　者：范星[1] 何超[1] 陈菁菁[1] 张苑菁 杨帆[1] 郭泽 钱丹凤 FAN Xing;HE Chao;CHEN Jingjing;ZHANG Yuanjing;YANG Fan;GUO Ze;QIAN Danfeng(Department of Dermatology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院皮肤科,安徽合肥230022

出　　处：《中国皮肤性病学杂志》2018年第9期1022-1028,共7页The Chinese Journal of Dermatovenereology

基　　金：中国皮肤影像资源库项目开放式研究基金计划(CSID-ORF-201707)

摘　　要：目的探讨寻常性银屑病、玫瑰糠疹、扁平苔藓、硬化萎缩性苔藓及光泽苔藓等丘疹鳞屑性皮肤病反射式共聚焦显微镜(reflectance confocal microscopy,RCM)下镜像特征及其在丘疹鳞屑性皮肤病辅助诊断中的意义。方法分析109例寻常性银屑病、15例玫瑰糠疹、52例扁平苔藓、5例硬化萎缩性苔藓和14例光泽苔藓患者的RCM图像特征和组织病理特点,比较二者的符合率。结果寻常性银屑病角化不全、银屑病样增生、真皮乳头血管迂曲扩张伴炎细胞浸润的RCM与组织病理有较高的符合率,但RCM的Munro微脓肿检出率偏低(54.13%);玫瑰糠疹局灶性角化不全及真皮浅层炎细胞浸润检出率二者高度一致,但RCM中表皮层海绵形成检出率较低(53.33%);扁平苔藓棘层增厚、基底细胞液化变性及真皮乳头炎细胞浸润检出率二者高度一致,但颗粒层楔形增厚的RCM图像仅有5例检测到(9.62%)。硬化萎缩性苔藓RCM及组织病理均可见到表皮变薄、基底细胞液化及真皮浅层炎细胞浸润,二者完全符合。光泽苔藓的真皮乳头扩大、表皮突下延、基底细胞液化及真皮乳头内噬黑素及炎症细胞浸润检出率二者高度一致。结论RCM可作为寻常性银屑病、玫瑰糠疹、扁平苔藓、硬化萎缩性苔藓及光泽苔藓等丘疹鳞屑性皮肤病较为理想的诊断及鉴别诊断辅助工具。Objective To assess the features of psoriasis vulgaris,pityriasis rosea,lichen planus,lichen sclerosus et atrophicus and lichen nitidus by reflectance confocal microscopy（RCM） and to investigate its clinic significance in the auxiliary diagnosis of skin diseases characterized mainly by papules and scalesMethods RCM and histopathological examination were performed for imaging of lesions in 109 patients with psoriasis vulgaris,15 with pityriasis rosea,52 with lichen planus,5 with lichen sclerosus et atrophicus（LSA） and 14 with lichen nitidusA coincidence rate was compared between confocal microscopic and histopathological findingsResults RCM images were highly consistent with histopathological findings in parakeratosis in psoriasis vulgaris,psoriasiform hyperplasia and twisted capillaries in dermal papillae and inflammatory infiltrate in the upper dermisHowever,RCM showed a lower detection rate of Munro microabscess（5413%）RCM imaging of lesions in patients with pityriasis rosea was highly consistent with histopathological findings in parakeratosis and infiltration of inflammatory cells in superficial layer of dermisRCM showed a lower detection rate of the formation of epidermal sponge（5333%）RCM imaging of lesions in lichen planus cases were highly consistent with histopathological findings in acanthosis,liquefaction degeneration of basal cells and inflammatory infiltrate in the upper dermisHowever,RCM indicated wedge-shaped thickening of the granular layer only in 5 cases（962%）RCM imagines were completely in accordance with histopathological findings in LSA,showing decrease or disappearance of the epidermis,liquefaction degeneration of the basal layer and the infiltration of inflammatory cells in the superficial dermisRCM imaging of lesions in lichen nitidus cases were highly consistent with histopathological findings in enlarged dermal papillae,epidermal downward extension,liquefaction degeneration of basal cell and inflammatory infiltrate in the upper dermisConclusionRCM can serve as an ideal

关 键 词：寻常性银屑病 玫瑰糠疹 扁平苔藓 硬化萎缩性苔藓 光泽苔藓 反射式共聚焦显微镜 

分 类 号：R758.63[医药卫生—皮肤病学与性病学] R758.64[医药卫生—临床医学]