皮肌炎皮肤病理特点以及与皮疹活动度的相关性  

Dermatopathological features of patients with dermatomyositisand its correlation with cutaneous disease activity

作　　者：江薇[1] 申雅文 田小兰[1] 王国春[1] 卢昕[1] Jiang Wei;Shen Yawen;Tian Xiaolan;Wang Guochun;Lu Xin(Department of Rheumatology,China-Japan Friendship Hospital,BeiJing,100029,China;China-Friendship Hospital attached to Peking University,Beijing 100029,China)

机构地区：[1]中日友好医院风湿免疫科,北京100029 [2]北京大学医学部中日友好临床医学院,100029

出　　处：《中华风湿病学杂志》2021年第7期441-444,I0002,共5页Chinese Journal of Rheumatology

基　　金：北京市科委首都临床特色应用(Z171100001017208)。

摘　　要：目的研究皮肌炎(DM)皮肤组织免疫病理特征及与皮疹活动度的相关性。方法收集42例我院诊治的DM患者的皮肤标本,对其皮肤病理特点进行Spearman相关性分析。两组间比较用χ^(2)检验或Fisher精确检验。建立多重线性回归模型分析皮肤病理表现与皮疹活动度评分的相关性。结果血管周围炎(37例,占88%)是DM最常见的皮肤病理表现,其次是表皮萎缩(22例,占52%)和黑色素细胞脱失(20例,占48%),基底细胞空泡样变性(15例,占36%)。在不同肌炎特异性抗体患者中,基底细胞空泡样变性(χ^(2)=9.110,P=0.022),界面性皮炎(χ^(2)=11.672,P=0.005)和黏蛋白沉积(χ^(2)=7.795,P=0.029)比例差异有统计学意义。TIF1-γ抗体阳性DM患者基底细胞空泡变和界面性皮炎的比例高,而MDA5抗体阳性患者界面性皮炎的比例低。相关性分析发现表皮萎缩(r=0.371,P=0.016)和角化不全(r=0.316,P=0.041)分别与界面性皮炎呈正相关,基底细胞空泡样变性与黑色素细胞脱失正相关(r=0.384,P=0.012)。分析皮肤病理表现与皮疹活动度的相关性发现,界面性皮炎与皮损面积和严重指数(CDASI)评分呈独立正相关(β=10.295,P=0.004)。结论DM不同亚组的皮肤病理表现存在差异。界面性皮炎与血管周围炎发病机制尚可能存在不同,是DM皮疹活动度的标志。而表皮角质细胞可能参与了界面性皮炎的病理生理过程。Objective To identify dermatopathological features of patients with dermatomyositis(DM)and analyze its correlation with cutaneous diseases activity.Methods The clinical data and skin biopsies of 48 patients were collected.The relevance was analyzed using Spearman's correlation analysis.The two groups were compared using Chi-square test or Fisher's exact test.Multi-factors line regression model was established to analyze the relationship between cutaneous disease activity and dermatopathological features.Results The most common dermatopathological feature was perivascular inflammation(37 cases,88%),followed by epidermal atrophy(22 cases,52%)and melanocyte loss(20 cases,48%),basal vacuolization(15 cases,36%).The incidence of basal vacuolization(χ^(2)=9.110,P=0.022),interface dermatitis(χ^(2)=11.672,P=0.005)and mucin deposition(χ^(2)=7.795,P=0.029)were significantly different in patients with myositis specific antibody(MSA)subgroup.The patients with positive tranional intermediary factor-1(anti-TIF1-γ)antibody had higher incidence of interface dermatitis and basal vacuolization,and patients with melanoma differentiation-associated gene 5(anti-MDA5)antibody had lower incidence of interface dermatitis.Interface dermatitis was positively associated with epidermal atrophy(r=0.371,P=0.016)and parakeratosis(r=0.316,P=0.041).Pigment inco-ntinence was positively associated with basal vacuolization(r=0.384,P=0.012).Multi-factor line regression showed interface dermatitis was positively related to cutaneous disease area and severity index(CDASI).Conclusion The dermatopathological features is different in subgroup of patients with DM(β=10.295,P=0.004).Interface dermatitis is a marker of cutaneous disease activity,and its pathogenesis may be different from that of perivascular inflammation.Keratinocytes may be involved in the pathological process in interface dermatitis.

关 键 词：皮肌炎 皮肤 疹 组织病理特征 皮疹活动度 

分 类 号：R593.26[医药卫生—内科学]