寻常型银屑病皮肤镜特征及皮损变化与血管关系的研究

发布时间：2018-01-11 22:03

本文关键词：寻常型银屑病皮肤镜特征及皮损变化与血管关系的研究　出处：《天津医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：皮肤镜(Dermoscopy)是一种直接在体观察皮肤各种微小结构、血管和色素改变等特征的无创性显微图像分析技术。皮肤镜可以观察到表皮、真皮乳头层和真皮深层等肉眼无法看到的影像结构与特征,这些特征在临床上与疾病在组织病理学的变化有着很大的对应关系,图像特征和病理的相互对应关系确定了皮肤镜疾病诊断的敏感性和特异性。目前,国内皮肤镜主要应用于色素性皮肤病方面,大大减少了以往对色素性皮损肉眼诊断的误诊率,并且皮肤镜的无创性避免了部分患者被盲目活检或因直接外科手术切除而造成的不必要的创伤。对于非色素性炎症性皮肤病,皮肤镜也可以通过研究皮损部位血管形态,分布模式、密度和其他特征进行鉴别和诊断,但国内研究较少,尚没有一个成熟的标准。银屑病(Psoriasis)是皮肤科临床一种常见、反复发生、与免疫相关的慢性炎症性皮肤病。本病发病率较高。其临床不典型病例确诊依据主要依靠病理诊断,痛苦性大,患者不易接受。无创性的检查方法越来越得到患者和医院的认可。目的:探讨寻常型银屑病各部位(躯干、面部、头皮、黏膜、指甲、掌趾)皮损的皮肤镜特征及其诊断意义;皮肤镜动态观察银屑病有效治疗后皮损血管的改变及其与皮损改变的相关性。方法:1.选取120例寻常型银屑病患者,使用皮肤镜研究其背景颜色、鳞屑颜色、低倍镜和高倍镜下血管形态、血管排列模式和血管走行方向,并统计其频率,所有数据均经SPSS10.0软件进行统计分析,统计各种图像的阳性率,描述各项指标灵敏度。2.选取30例持续治疗的银屑病患者于治疗0、1、2、3、4、6周使用皮肤镜做皮损处血管变化的动态连续性观察,并于同一时间对同一皮损做红斑、鳞屑、浸润的评分并记录,比较皮损血管变化及与皮损变化的关系。结果:1.寻常型银屑病主要皮肤镜特征主要为低倍镜下红色背景、银白色鳞屑、血管规则排列模式、点/球状血管和高倍下肾小球样血管,其中头皮部位高倍镜下以肾小球样血管和非典型血管为主;黏膜改变未观测到明显鳞屑。掌趾部位图像特征低倍镜下红色背景、银白色鳞屑、低倍下点/球状血管沿皮嵴呈线状均匀规则排列、高倍下肾小球样血管;甲改变主要表现为甲板可见多发性小坑、远端甲剥离,线状出血,鲑鱼补丁;甲小皮可见迂曲扩张血管呈不规则分布; 近端甲皱血管形态改变,无明显模式。2.a.银屑病有效治疗后,皮损处血管往正常回归,血管直径变小,血管球截面积变小。b.疗效相对指数与血管相对指数、疗效相对指数评分与血管球相对指数评分随时间变化的变化趋势为0-4周增加,4-6周降低。c.疗效相对指数及血管相对指数呈正相关,R=0.914,p0.01,具有统计学意义。d.疗效相对指数评分及血管球相对指数评分呈正相关,R=0.894,p0.01,具有统计学意义。结论:1.本次研究显示,皮肤镜下寻常型银屑病血管及鳞屑等模式,可用于临床辅助鉴别和诊断。2.银屑病皮损变化与血管直径、血管球截面变化呈正相关,提示皮损血管变化观察可用于银屑病恢复情况及药物疗效的观察。
[Abstract]:Dermoscopy (Dermoscopy) is a kind of direct observation in vivo skin micro structure, noninvasive microscopic image analysis technology. The characteristics of blood vessels and pigmentation of skin epidermal mirror can be observed, the image structure and characteristics of the dermal papilla layer and deep dermis, the naked eye can not see, these characteristics and changes in disease in clinic histopathology of the large, corresponding relationship between image features and pathology confirmed the diagnosis of skin diseases with sensitivity and specificity. At present, the domestic dermoscopy is mainly used in pigmented skin diseases, greatly reducing the misdiagnosis of previous diagnosis of pigmented skin lesions and skin of the eye, no mirror to avoid invasive part of trauma patients were caused by blind biopsy or resection surgery is not directly necessary. For the non pigmented inflammatory skin disease, the skin can also mirror through the research Morphology, vascular lesions distribution pattern, density and other characteristics identification and diagnosis, but the domestic research is still not a mature standard. Psoriasis (Psoriasis) is a common clinical department of Dermatology, recurrent, chronic inflammatory skin disease associated with immune. The incidence of this disease is high. The atypical clinical features on the basis of cases mainly depends on the pathological diagnosis, the pain of the patients, is not easy to accept. Noninvasive examination more and more patients and hospital accreditation. Objective: To investigate the various parts of psoriasis vulgaris (face, torso, head, skin, mucosa, nails, metacarpophalangeal) dermoscopic features of lesions and its clinical significance; to observe the dynamic changes of vascular lesions of skin mirror the effective treatment of psoriasis and its correlation with change after lesions. Methods: 1. selected 120 cases of patients with psoriasis vulgaris, to study the background color, use the skin color mirror scales, low power High magnification microscope and vascular morphology, vascular pattern and vascular direction, and statistical frequency, all the data were analyzed by SPSS10.0 software, the positive rate of statistics of all kinds of image, observe the dynamic description indicators of the sensitivity of.2. to select 30 cases of continuous treatment in patients with psoriasis in the treatment of skin lesions using mirror 0,1,2,3,4,6 weeks Department of vascular changes continuously, and at the same time on the same lesions of erythema, scaling, infiltration were recorded, compared with lesions of vascular changes and the change of the lesions. Results: 1. psoriasis vulgaris main dermoscopic features are mainly low magnification, red background, silver white scales, vascular rules permutation pattern / spherical vessels and high magnification of glomeruloid vascular, the scalp at high magnification with glomeruloid vascular and non vascular; mucosal changes were not observed significant toe palm scales. A low magnification image feature red background, silver white scales, low magnification / spherical vessels along the ridge in a linear uniform arrangement, high magnification of glomeruloid vascular changes for the main deck; a visible multiple small pits, distal onycholysis, linear hemorrhage, salmon patch; a small skin visible tortuous dilated vessels showed irregular distribution; the proximal nailfold vessels, no obvious pattern of.2.a. is effective in the treatment of psoriasis, vascular lesions to the normal regression, blood vessel diameter becomes smaller, the section area and the relative index of glomus.B. small vascular relative efficacy index, relative efficacy index and relative index score glomus trend with time the increase in the variance for 0-4 weeks, 4-6 weeks to reduce the effect of.C. relative index and relative vascular index is positively correlated with R=0.914, P0.01,.D. was statistically significant relative efficacy index and relative index score was glomus Positive correlation, R=0.894, P0.01, have statistical significance. Conclusion: 1. this study shows that psoriasis vulgaris and vascular patterns of skin scales under the microscope, can be used for clinical diagnosis of.2. and differential diagnosis of psoriatic lesions and changes of vascular diameter, glomus section changes were positively correlated to observe the change of vascular lesions that can be used to observe the curative effect of psoriasis drug recovery.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R758.63

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