进行性斑状色素减少症的临床及实验研究

发布时间：2018-05-08 11:06

本文选题：进行性斑状色素减少症 + 致病菌　；参考：《安徽医科大学》2010年硕士论文

【摘要】： 背景:进行性斑状色素减少症(PMH)是一种较为常见的色素减退性疾病,由Guillet在1988年首次报道。其典型的临床特征为发生于躯干前后、边界欠清的椭圆形色素减退斑,可于近中线处融合成片状。常被误诊为其他色素减少性疾病(如花斑癣、炎症后色素减退等)。到目前为止PMH的病因仍然是不清的。目的:研究进行性斑状色素减少症(PMH)的临床特点,并从多个角度进行实验研究,探究其发病机制及总结该病的诊断要点。同时对该病进行针对性治疗。方法:应用Wood灯及活体共聚焦激光扫描显微镜(皮肤CT)观察皮损特点、致病菌培养、黑素细胞培养,并应用S-100和TRP-1免疫组化分析皮损区黑素细胞数量、电镜观察其超微结构特征。结果:Wood灯检查示皮损区可见点状红色荧光,皮肤CT观察示皮损区色素环完整,但与周围正常皮肤相比其内所含的黑素颗粒含量减少。致病菌培养可见产红色荧光的G+棒状杆菌,经鉴定为痤疮丙酸杆菌。S-100染色示皮损区阳性细胞数(8.25±0.96)与周围正常皮肤(8.75±1.71)相比无统计学意义(P0.05);TRP-1染色示皮损区阳性细胞数(4.25±0.96)与周围正常皮肤(4.50±1.29)相比也无统计学意义(P0.05);T311染色示皮损区阳性细胞数与正常皮肤相比亦无差异。电镜观察发现皮损区IV期黑素小体的数量明显下降,并观察到较多的膜结合体,内含成簇状分布的多个体积较小的II-IV期黑素小体。成功培养出黑素细胞,其形态与正常细胞相比未见明显异常。结论:根据我们的临床及实验研究,提出了进行性斑状色素减少症的临床诊断要点。1)好发于青年患者,无家族史。2)皮损以圆形或椭圆形,边界欠清的色素减退斑为特征,无鳞屑,且边缘无色素沉着,无感觉异常。3)主要发生于背部、腹部,可于近中线处融合成片状,并可泛发于颈部、四肢近端等。4)Wood灯下可见色素减退区存在局限性点状红色荧光,皮肤共聚焦激光扫描显微镜观察示皮损区‘色素环’正常,但与周围正常皮肤相比其内所含的色素颗粒减少。5)皮损区细菌培养可培养出痤疮丙酸杆菌,真菌镜检及培养阴性。6)组织学检查示皮损区黑素细胞数量无明显减少。7)超微结构观察皮损区及皮损边缘外观正常皮肤内可见较多的膜结合体(内含多个体积较小的II-IV期黑素小体)。过氧化苯甲酰联合NB-UVB是治疗进行性斑状色素减少症的一种有效的方法。
[Abstract]:Background: progressive pigmentopenia (Guillet) is a common hypochromic disease, which was first reported by Guillet in 1988. The typical clinical features are oval hypochromic spots which occur before and after torso, and can be fused into flakes at the proximal midline. It is often misdiagnosed as other hypochromic diseases, such as tinea versicolor, postinflammatory hypopigmentation, etc. So far, the cause of PMH is still unclear. Objective: to study the clinical features of progressive pigmentopenia (PMH), and to explore the pathogenesis and diagnosis of PMH from many aspects. At the same time, the targeted treatment of the disease was carried out. Methods: Wood lamp and confocal laser scanning microscope (CTT) were used to observe the characteristics of skin lesions, pathogenic bacteria culture, melanocyte culture, and S-100 and TRP-1 immunohistochemical analysis of the number of melanocytes in the lesions. The ultrastructural characteristics were observed by electron microscope. Results the skin lesions showed dot red fluorescence by the W Wood lamp. Skin CT showed that the pigment ring of the lesions was intact, but the content of melanin granules in the lesions was lower than that in the surrounding normal skin. The G corynebacterium producing red fluorescence can be found in the culture of pathogenic bacteria. The number of positive cells in the lesions identified as Propionibacterium acnes was 8.25 卤0.96) and that in the surrounding normal skin was 8.75 卤1.71). There was no significant difference in the number of positive cells in the lesions by P0.05 and TRP-1 staining (4.25 卤0.96) and in the normal skin around the skin (4.50 卤1.29). Staining showed that there was no difference in the number of positive cells between the lesions and normal skin. Electron microscopy showed that the number of melanosomes in stage IV of the lesions was significantly decreased, and more membrane junctions were observed, which contained a number of smaller melanosomes in the II-IV phase, which were distributed in clusters. Melanocytes were successfully cultured and their morphology was not significantly abnormal compared with normal cells. Conclusion: according to our clinical and experimental studies, the main points of clinical diagnosis of progressive pigmentopenia are as follows: 1) it is easy to occur in young patients, and no family history. 2) the lesion is characterized by round or elliptical pigmentation with unclear boundary. No scales, no pigmentation at the edge, no sensory abnormality. 3) mainly occurred in the back, abdomen, can fuse into flakes at the near midline, and can be found in the neck, proximal extremities, etc., there are localized spots of red fluorescence in the hypochromatic region, such as the neck, the proximal end of the extremities, and so on. The confocal laser scanning microscope showed that the pigment ring in the lesions was normal, but the pigment particles in the lesions were less than those in the surrounding skin. 5) Propionibacterium acnes could be cultured in the lesions. Microscopic examination of fungi and culture negative. 6) histological examination showed that the number of melanocytes in the lesions was not significantly decreased. 7) Ultrastructure observation showed that there were more membrane junctions in the lesions and the edges of the lesions. The melanosome of II-IV. Benzoyl peroxide combined with NB-UVB is an effective method for the treatment of progressive pigmentopenia.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R758.4

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