新发麻风患者35例临床和病理分析  

Clinical and Pathological Analysis of 35 New Leprosy Cases

作　　者：周海园 吴玮 周顺婷 王翠媚 韩敬端 ZHOU Haiyuan;WU Wei;ZHOU Shunting;WANG Cuimei;HAN Jingduan(Affiliated Hospital of Guangdong Medical University,Zhanjiang 524000,China)

机构地区：[1]广东医科大学附属医院,广东湛江524000

出　　处：《中国皮肤性病学杂志》2024年第10期1108-1113,共6页The Chinese Journal of Dermatovenereology

摘　　要：目的分析2013—2020年来本院就诊的新发麻风患者的临床和病理特点,以期减少临床医生对麻风的漏诊和误诊。方法皮疹行活检组织HE切片和Ziehl-Neelsen抗酸染色,从广东省麻风上报系统中查找麻风患者临床分型和6部位皮肤组织液涂片抗酸染色细菌指数。结果麻风50岁以上患者占比51.43%,有5个家庭共11名患者先后患病。中间界限型(BB)和界限偏瘤型(BL)的误诊率分别为38.46%及50.00%,少菌型麻风未出现误诊;35例患者中6例出现眉毛脱落,4例出现足底溃疡,所有病例均未提及眼部症状,所有BB和BL患者均有结节性红斑样皮疹和/或手足背和肢端的暗红水肿;神经受损症状发生率约为37.14%,结核样型(TT)和界限偏结核样型(BT)发生率均为50.00%;20.00%患者出现皮疹瘙痒。所有皮疹病理示真皮和/或皮下组织肉芽肿改变;5例BB、6例BL出现脂膜炎改变,其中2例BL见大量浆细胞浸润;2例BB多次抗酸染色阴性而6部位组织液涂片抗酸染色阳性。结论麻风的临床表现多样,眉毛脱落、足底溃疡、眼部症状以及感觉障碍等在本研究中不占主导地位;慢性全身泛发结节性红斑样皮疹和/或四肢末端暗红肿胀需要高度怀疑BB和BL型麻风;皮损真皮和/或皮下组织病理发现肉芽肿改变,都需要初筛麻风,目前病理的抗酸染色技术有待改进。总之,麻风的诊断和分型需结合临床表现、病理、病理抗酸染色和6部位皮肤组织液涂片抗酸染色的综合判断。Objective To analyze the clinical and pathological characteristics of newly diagnosed leprosy patients visiting our hospital from 2013 to 2020,aiming to reduce the rate of missed and misdiagnosed cases of leprosy among clinicians.Methods HE staining and Ziehl-Neelsen acid-fast staining were performed on biopsy tissues of skin lesions.The clinical classifications of leprosy and acid-fast bacterial indices from skin tissue fluid smears taken from six body parts were retrieved from the Guangdong Provincial Leprosy Reporting System.Results Among leprosy patients,those aged above 50 constitute 51.43%,with 11 patients from 5 families successively affected by the disease.The misdiagnosis rates for borderline(BB)and borderline-lepromatous(BL)leprosy are 38.46%and 50.00%,respectively,while paucibacillary leprosy has not been misdiagnosed.Among 35 cases,6 patients experienced eyebrow loss and 4 patients had plantar ulcers;ocular symptoms were not reported in any case.All BB and BL patients exhibited nodular erythematous rashes and/or dark red edema on the dorsal aspects of hands,feet,and extremities.The prevalence of neuropathic symptoms is approximately 37.14%,with both tuberculoid(TT)and borderline-tuberculoid(BT)leprosy occurring at a rate of 50.00%.Pruritus associated with skin lesions was observed in 20.00%of patients.Histopathology of all skin rashes revealed granulomatous changes in the dermis and/or subcutaneous tissue;panniculitis changes were observed in 5 BB and 6 BL patients,with 2 BL patients showing significant plasma cell infiltration.Two cases of BB had multiple negative acid-fast stains,but were positive on smears from six different tissue fluid samples.Conclusion The clinical manifestations of leprosy are diverse,and eyebrow loss,plantar ulceration,eye symptoms,and sensory impairment did not dominate in this study.Chronic generalized nodular erythema-like skin lesions and/or dark red swelling at the extremities require a high suspicion of BB and BL leprosy.The detection of granuloma changes in the dermis

关 键 词：麻风 临床特征 病理 

分 类 号：R755[医药卫生—皮肤病学与性病学]