司库奇尤单抗治疗前后银屑病局部皮损皮肤镜和反射式共聚焦显微镜特征分析  

Analysis of dermoscopic and reflectance confocal microscopic features of psoriatic lesions before and after treatment with secukinumab

作　　者：乔嘉熙 夏萍[1] 陈柳青[1] Qiao Jiaxi;Xia Ping;Chen Liuqing(Department of Dermatology,Wuhan No.1 Hospital,Wuhan 430000,China;Department of Dermatology,General Hospital of the Yangtze River Shipping,Wuhan 430000,China)

机构地区：[1]武汉市第一医院皮肤科,武汉430000 [2]长江航运总医院皮肤科,武汉430000

出　　处：《中华皮肤科杂志》2024年第9期825-829,共5页Chinese Journal of Dermatology

摘　　要：目的利用皮肤镜及反射式共聚焦显微镜(RCM)分析司库奇尤单抗短期治疗前后银屑病局部皮损的微观形态改变,为银屑病疗效监测提供可靠的微观指标。方法选取2021年7-12月武汉市第一医院皮肤科接受司库奇尤单抗治疗的19例中重度斑块状银屑病患者,在治疗的第0、2、4周使用皮肤镜及RCM对每例患者同一皮损进行检测,并同时进行临床评分,统计分析治疗前后临床评分变化、皮肤镜评分及RCM特征变化情况。结果皮肤镜观察显示,治疗2~4周后,银屑病皮损鲜红色背景逐渐变浅,色素沉着逐渐增加,鳞屑明显减少,点状/球状血管由均匀规则分布变为聚集分布或完全消失。RCM显示,经过2周及4周治疗后,表皮厚度减少,第0、2、4周角质层到真皮乳头层的厚度分别为(76.85±21.08)μm、(56.93±16.58)μm、(52.45±15.76)μm,角化不全减轻或消失,真表皮炎症细胞数量减少或消失,真皮乳头内血管扩张减轻且真皮乳头周围色素环结构逐渐恢复明亮,真皮乳头直径减小,第0、2、4周真皮乳头直径分别为(53.96±4.65)μm、(45.54±5.11)μm、(41.47±4.54)μm。结论银屑病皮损处微观指标的改变与临床疗效密切相关,其中RCM下真皮乳头边缘色素环结构的恢复可作为银屑病皮损炎症得到控制的早期观测指标及后期治疗起效的早期预测指标之一。Objective To analyze micromorphological changes in psoriatic lesions before and after short-term treatment with secukinumab by dermoscopy and reflectance confocal microscopy(RCM),and to provide reliable microscopic indicators for monitoring the treatment efficacy.Methods Nineteen patients with moderate to severe plaque psoriasis treated with secukinumab were collected from the Department of Dermatology,Wuhan No.1 Hospital between July and December 2021.Dermoscopy and RCM were performed on same lesions in every patients at weeks 0,2,and 4 after the start of treatment,and clinical evaluation was conducted at the same time.The changes in clinical scores,dermoscopic scores,and RCM characteristics before and after treatment were analyzed.Results Dermoscopy showed that the bright red background of psoriatic lesions gradually lightened,pigmentation gradually increased,scales markedly decreased,and dotted/globular vessels changed from a uniform and regular distribution pattern to a clustered distribution pattern or completely disappeared after 2 to 4 weeks of treatment.As RCM revealed,after 2 and 4 weeks of treatment,the epidermal thickness decreased;the thicknesses from the stratum corneum to the dermal papilla at weeks 0,2,and 4 were 76.85±21.08μm,56.93±16.58μm,and 52.45±15.76μm,respectively;epidermal parakeratosis was alleviated or disappeared,inflammatory cells also decreased in number or disappeared in the epidermis and dermis,vascular dilatation was alleviated in the dermal papilla,and the structure of dermal papillary rings gradually became brighter in color after the treatment;the diameters of the dermal papillae decreased,measuring 53.96±4.65μm,45.54±5.11μm,and 41.47±4.54μm at weeks 0,2,and 4,respectively.Conclusion The changes of microscopic indicators in psoriatic lesions are closely related to clinical efficacy,and the recovery of the dermal papillary ring structure by RCM can serve as an early observational indicator for the control of inflammation in psoriatic lesions and as an early predictive

关 键 词：银屑病 生物制剂 皮肤镜 显微镜检查 共焦 治疗 司库奇尤单抗 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]