甲真菌病、甲银屑病患者的临床分型与皮肤镜表现  

Clinical classification and dermatoscope observation of patients with onychomycosis and psoriasis

作　　者：王敬茶 刘雪 尹鸿英 周娜娜 邱思思 景伟芳 WANG Jingcha;LIU Xue;YIN Hongying;ZHOU Nana;QIU Sisi;JING Weifang(Department of Dermatology,Hebei Central Hospital for Oil&Technology,Langfang 065000,China)

机构地区：[1]河北中石油中心医院皮肤科,廊坊065000

出　　处：《中国真菌学杂志》2024年第6期601-606,共6页Chinese Journal of Mycology

基　　金：廊坊市科技技术研究与发展计划项目(2020013130);河北省省级科技计划(182177132)。

摘　　要：目的研究甲真菌病、甲银屑病患者的临床分型、皮肤镜表现,为甲真菌病和甲银屑病患者的临床诊治提供参考。方法选取2020年4月—2022年12月于河北中石油中心医院就诊的175例甲真菌病患者与168例甲银屑病患者的临床资料,并分别纳入真菌病组与银屑病组。真菌病组与银屑病组均接受皮肤镜检查,统计真菌病组与银屑病组一般资料、临床分型与皮肤镜检查结果,比较皮肤镜检查诊断对甲真菌病与甲银屑病不同临床分型的检出率,同时分析甲真菌病与甲银屑病患者的皮肤镜表现。结果真菌病组175例患者中远端侧位甲下型、全甲毁损型、白色浅表型、近端甲下型占比分别为30.29%、29.71%、20.57%、19.43%,银屑病组168例患者寻常型、脓疱型、红皮病型、关节病型占比分别为81.55%、7.74%、5.36%、5.36%。皮肤镜检查对真菌病组的检出率为89.71%,对银屑病组的检出率82.73%,差异无统计学意义(P>0.05);皮肤镜检查对真菌病组、银屑病组各类型患者的检出率均高于80%。真菌病组皮肤镜表现中占比较高的主要为甲破坏、甲下角化过度、纵向条纹、锯齿状边缘,银屑病组皮肤镜表现中占比较高的主要皮肤镜表现为甲分离、甲板点状凹陷、油斑、甲周软组织血管改变、假性纤维征,差异有统计学意义(P<0.05);而两组皮肤镜表现为碎片状出血占比比较差异无统计学意义(P>0.05)。结论甲真菌病临床分型为全甲毁损型、远端侧位甲下型者占比较高,甲银屑病临床分型则除寻常型外,脓疱型占比较高;而甲真菌病与甲银屑病患者皮肤镜表现出明显差异,皮肤镜检查对其不同病灶分型的检出率较高,鉴别效果良好。临床可通过皮肤镜检查对甲真菌病与甲银屑病进行鉴别,并根据患者皮肤镜表现、病灶分型等予以针对性治疗与干预。Objective To study the clinical classification and dermatoscope of patients with onychomycosis and nail psoriasis,and to provide reference for clinical diagnosis and treatment of onychomycosis and nail psoriasis.Methods The clinical data of 175 patients with onychomycosis and 168 patients with psoriasis nail in Hebei Petro China Central Hospital from April 2020 to December 2022 were selected and included into the onychomycosis group and the psoriasis group respectively.Both groups received dermoscopy examination,and the general data,clinical classification and dermatoscope examination results of nail psoriasis group and psoriasis group were counted.The clinical classification of different focus types of onychomycosis and nail psoriasis were compared,and the dermoscopy manifestations of patients with onychomycosis and nail psoriasis were analyzed.Results Among the 175 patients in fungal group,the proportions of distal and lateral subungual onychomycosis,total dystrophic onychomycosis,superficial white onychomycosis and proximal subungual onychomycosis were 30.29%,29.71%,20.57%and 19.43%respectively.In the psoriasis group,the proportions of 168 patients with normal type,pustular type,erythroderma type and arthropathy type were 81.55%,7.74%,5.36%and 5.36%respectively.The detection rate of dermatoscope in the onychomycosis group was 89.71%,and there was no significant difference compared with that in the psoriasis group(82.73%)(P>0.05).The detection rate of dermatoscopy in patients with mycosis and nail psoriasis was higher than 80%.In the onychomycosis group,nail destruction,hyperkeratosis under the nail,longitudinal stripes and serrated edges were the main dermatoscope manifestations, while in the psoriasis group, nail separation, punctate depression on the deck, oil spots, changes of blood vessels in soft tissues around the nail and false fibrous sign were the main dermatoscope manifestations, with statistical significance ( P <0.05). However, there was no significant difference in the proportion of patients with

关 键 词：甲真菌病 甲银屑病 皮肤镜 鉴别 

分 类 号：R756.4[医药卫生—皮肤病学与性病学]