非感染性甲病的临床、皮肤影像特征在诊断中的意义  

The Significance of Clinical Manifestations and Skin Imaging in Diagnosis of Non-Infectious Onychopathy

作　　者：尹莉 朱晶 YIN Li;ZHU Jing(Department of Dermatology,Wuxi People′s Hospital Affiliated to Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院皮肤科,江苏无锡214023

出　　处：《皮肤科学通报》2024年第2期170-178,共9页Dermatology Bulletin

摘　　要：目的结合非感染性甲病的皮肤影像资料及病理结果,予以分析并总结皮肤影像要点,进一步提高非感染性甲病诊断的准确性。方法选取2022年01月—2023年12月,同时行甲活检及皮肤影像检查的甲病患者48例,收集临床、组织病理及皮肤影像图像并加以分析。结果在单指(趾)受累的甲病中,甲血管球瘤、甲乳头状瘤、甲银屑病及甲扁平苔藓在皮肤镜下均可出现纵向条索样红斑及血管扩张,其中甲乳头状瘤还可见特征性甲下角化性团块;甲下外生骨疣及甲下鳞状细胞癌均表现为均质样增生结构,但甲下鳞状细胞癌背景较红,病变边缘模糊,亦可见树枝状血管及出血。对于多指(趾)受累的甲病(甲银屑病、甲扁平苔藓等),则有多种不同的皮肤镜特征并存;与甲银屑病相比,甲扁平苔藓中甲纵裂比率升高,差异有统计学意义(P<0.05);与甲扁平苔藓相比,甲银屑病中点状凹陷及油滴样结构比率升高,差异有统计学意义(P<0.05)。皮肤彩超多普勒示几乎所有甲下血管球瘤均表现为甲板下低回声结节,并显示丰富血流信号。结论皮肤镜、皮肤超声等皮肤影像技术对非感染性甲病的诊断有极高的参考价值。Objective The main points were analyzed and summarized combined with the medical imaging data and pathological results,which further improving the diagnosis accuracy of noninfectious onychopathy.Methods The study included a total of 48 patients diagnosed with onychopathy who underwent simultaneous nail biopsy and imaging examination from January 2022 to December 2023.The collected images were subsequently analyzed.Results For cases of onychopathy involving a single finger(toe),dermoscopic examination revealed longitudinal cord-like erythema and vascular expansion in onychoglobus,onychopapilloma,psoriasis and onycholichen planus,among which onychopapilloma also showed characteristic subungual keratinized mass.Both subungual exostosis and subungual squamous cell carcinoma exhibited homogeneous proliferative structures;however,the background of subungual squamous cell carcinoma appeared erythematous,with indistinct lesion margins,accompanied by dendritic vessels and evidence of bleeding.Different imaging manifestations can be observed in onychopathy cases of involving multiple fingers(toes),such as psoriasis and lichen planus.Dermoscopy reveals that the ratio of longitudinal nail clefts is significantly higher in cases of nail lichen planus compared to those with nail psoriasis(P<0.05).Furthermore,there is a statistically significant increase in the proportion of punctate depressions and oil droplet structures in psoriasis when compared to lichen planus(P<0.05).Ultrasound in dermatology showed that almost all subungual glomus tumors were subungual low echo nodules with rich blood flow signals.Conclusion Imaging technology such as dermoscopy and ultrasonography has a high reference value for the diagnosis of non-infectious onychopathy.

关 键 词：非感染性 甲病 皮肤镜 皮肤超声 

分 类 号：R758.72[医药卫生—皮肤病学与性病学]