大疱性类天疱疮和天疱疮光学相干断层扫描成像特征比较  

Comparison of optical coherence tomography imaging features between bullous pemphigoid and pemphigus

作　　者：陈瑶[1] 余浪 姜倩[1] 喻惠元 陈柳青[1] 陈金波[1] Chen Yao;Yu Lang;Jiang Qian;Yu Huiyuan;Chen Liuqing;Chen Jinbo(Department of Dermatology,Wuhan No.1 Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院皮肤科,武汉430022

出　　处：《中华皮肤科杂志》2025年第3期216-220,共5页Chinese Journal of Dermatology

基　　金：湖北省第二届(2024-2027年)医学青年拔尖人才项目。

摘　　要：目的评估大疱性类天疱疮(BP)和天疱疮的光学相干断层扫描(OCT)成像特征。方法收集2024年1-6月武汉市第一医院经临床表现、组织病理学和免疫学确诊的BP患者23例和天疱疮患者18例。采用OCT成像对41例患者皮损部位的水疱及其解剖位置(表皮内或表皮下)、疱内炎症细胞和纤维蛋白沉积、真皮上层的扩张血管以及皮损旁皮肤进行评估。结果23例BP和18例天疱疮(寻常型12例,落叶型6例)患者中,男20例,女21例,发病年龄20~89岁。BP患者水疱OCT成像显示表皮下卵圆形至圆形液性暗区,内伴高折光炎症细胞和纤维蛋白沉积,真皮上层可见扩张的血管;天疱疮患者水疱OCT成像可见表皮内水疱伴少量炎症细胞;二者OCT特征与对应的组织病理特征表现相似。BP患者水疱内炎症细胞和纤维蛋白沉积的检出率(82.61%,19/23;60.87%,14/23)高于天疱疮患者(44.44%,8/18;11.11%,2/18;χ2=6.54、10.51,P=0.011、0.001)。疱旁正常皮肤OCT成像中,17.39%(8/46)的BP和25.00%(9/36)的天疱疮患者检测到亚临床裂隙。结论OCT成像可精确定位BP和天疱疮患者的水疱和疱旁正常皮肤潜在的亚临床病变,有助于两种疾病的早期辅助诊断。Objective To investigate the optical coherence tomography(OCT)imaging features of bullous pemphigoid(BP)and pemphigus.Methods A total of 23 patients with BP and 18 with pemphigus diagnosed according to clinical manifestations,histopathological and immunological features were collected from Wuhan No.1 Hospital from January to June 2024.OCT imaging was performed in 41 patients to observe the blisters at the lesion sites and their anatomic locations(intraepidermal or subepidermal),intravesicular inflammatory cells and fibrin deposits,dilated vessels in the upper dermis,as well as skin adjacent to the lesions.Results Among the 23 patients with BP and 18 patients with pemphigus(including 12 with pemphigus vulgaris and 6 with pemphigus foliaceus),there were 20 males and 21 females,and their ages at onset ranged from 20 to 89 years.OCT imaging of blisters in patients with BP showed subepidermal oval to round hyporeflective liquid-filled areas containing highly refractive inflammatory cells and fibrin deposits,with dilated vessels in the upper dermis,while OCT imaging of blisters in patients with pemphigus showed intraepidermal blisters with a few inflammatory cells;the OCT imaging features of both BP and pemphigus were similar to their corresponding histopathological features.The detection rates of intravesicular inflammatory cells and fibrin deposition were significantly higher in the patients with BP(82.61%[19/23],60.87%[14/23],respectively)than in those with pemphigus(44.44%[8/18],11.11%[2/18];χ2=6.54,10.51,P=0.011,0.001,respectively).In the OCT images of normal skin adjacent to blisters,subclinical fissures were detected in 17.39%(8/46)of patients with BP and 25.00%(9/36)of patients with pemphigus.Conclusion OCT imaging could accurately locate the blisters and potential subclinical lesions in normal skin adjacent to blisters in patients with BP and pemphigus,which is helpful for the early auxiliary diagnosis of these two diseases.

关 键 词：类天疱疮 大疱性 天疱疮 光学相干断层扫描 诊断 

分 类 号：R75[医药卫生—皮肤病学与性病学]