共聚焦激光扫描显微镜检测不同中医证型银屑病皮损的临床意义研究

发布时间：2018-06-18 17:14

本文选题：银屑病 + 共聚焦激光扫描显微镜　；参考：《南京中医药大学》2016年硕士论文

【摘要】：共聚焦激光扫描显微镜(confocal laser scanning microscopy, CLSM)这一近阶段快速发展起来的皮肤成像系统的产生基于共聚焦原理,它结合了光学显微镜、激光扫描和计算机图像处理技术,主要由激光光源、共焦系统、计算机系统等组成。这是近年来发展较快的一种无创的皮肤影像学检查和诊断技术,也被称为“皮肤CT”,它的诞生与激光、视频、计算机等技术的飞速发展密不可分。具有原位、在体、实时、动态、三维成像的特点。其无创、在体的特点决定了在进行皮肤影像学诊断时,减少了制作传统病理切片时的人为影响因素,更为客观和便捷。虽然人们在在日常生活中并未感受到银屑病的常见,但其患者仍是皮肤科“常客”,这一疾病在临床上常常呈现为红斑基础上的银白色云母状鳞屑、薄膜现象、点状出血现象。除了这些肉眼可见的、或者是经过简单临床检查手段可得到的表现,该病还会伴有难以忍受的瘙痒感,当患者由于皮肤损害处瘙瘁难忍将皮肤抓破后,还可以出现刺痛感。本课题将利用共聚焦激光显微镜观察银屑病不同中医证型的患者皮肤损害处的皮肤结构变化,获得具有典型性的图像,总结不同证型银屑病患者CLSM成像特征,进而为利用CLSM对银屑病进行更准确的中医分型及对症治疗提供辅助诊断和参考依据。本课题主要由三个部分组成： (1)利用共聚焦激光扫描显微镜观察健康志愿者的皮肤结构为第一部分。利用机器检查健康志愿者上肢和(或)下肢部位的健康皮肤,总结正常人皮肤的CLSM成像；(2)利用共聚焦激光扫描显微镜观察银屑病不同中医证型的患者的皮损处皮肤图像为第二部分,并记录相应数据；(3)将患者按照中医传统望、闻、问、切的诊断手法得到的结果进行四诊合参,分为血热证、血燥证、血瘀证三种证型,并对不同证型患者典型皮损处的CLSM成像特点进行统计分析与总结为第三部分。本课题第一部分得到了正常皮肤的CLSM成像特征；第二部分得到银屑病患者皮损处CLSM图像特点,并总结出银屑病患者皮损是以角化过度或(和)角化不全,Munro微脓肿,真皮乳头向上延伸,毛细血管迂曲扩张、充血,银屑病增生模式,基底色素缺失或减退,颗粒层缺如或变薄,棘层增厚,真皮乳头炎症细胞浸润,表皮内可见散在的炎症细胞移入为主要皮肤结构变化的特点；第三部分得出银屑病患者中医证型不同,其皮损在CLSM下成像亦具有不同特点：血热证主要以毛细血管迂曲扩张充血(88.9%)、Munro微脓肿(86.1%)及真皮乳头上顶(86.1%)三种特征为主。血燥证主要以角化过度(75%)、角化不全(75%)及毛细血管迂曲扩张充血(75%)三种特征为主。血瘀证主要以毛细血管迂曲扩张充血(100%)、Munro微脓肿(85.7%)及角化不全(85.7%)三种特征为主。实验结论：共聚焦激光扫描显微镜诊断银屑病具有一定特征性。共聚焦激光扫描显微镜检查能够对银屑病进行更准确的中医分型,有利于加强后续治疗的针对性,有助于降低误诊概率,提高临床治疗有效率。CLSM检查是原位、无创、在体、迅速、准确的,其在皮肤科其他疾病的诊断领域将会有更多样的应用。
[Abstract]:Confocal laser scanning microscope (confocal laser scanning microscopy, CLSM) this recent rapid development of the skin imaging system is based on confocal principle. It combines optical microscope, laser scanning and computer image processing technology, mainly composed of laser light source, confocal system, computer system and so on. The rapid development of a non-invasive imaging and diagnostic technique for skin imaging, also known as "skin CT", is inseparable from the rapid development of laser, video, computer and other technologies. It has the characteristics of in situ, in vivo, real-time, dynamic, and three-dimensional imaging. Its noninvasive, in body characteristics determine the diagnosis of skin imaging, It is more objective and convenient to reduce the human influence factors in making traditional pathological sections. Although people do not feel the common occurrence of psoriasis in their daily life, the patients are still a "regular guest" in the Department of dermatology. The disease is often clinically characterized by silver white mica scales on the basis of erythema, film phenomenon, and punctate bleeding. Elephants can be accompanied by unbearable itching, as well as unbearable itching, in addition to these naked eyes, or simple clinical examination. The subject will use confocal laser microscopy to observe the different TCM Syndromes of psoriasis with a confocal laser microscope. The change of skin structure in the skin lesion of the patient was made to obtain typical images, summarize the CLSM imaging features of patients with different psoriasis, and then provide auxiliary diagnosis and reference for more accurate TCM Typing and symptomatic treatment of psoriasis using CLSM. This topic mainly consists of three parts: (1) using confocal laser The skin structure of healthy volunteers was observed in the first part of the scanning microscope. The healthy skin of the upper and / or lower extremities of healthy volunteers was examined by machine. CLSM imaging of normal skin was summarized. (2) the skin lesions of patients with different TCM Syndromes of psoriasis using confocal laser scanning microscope were second parts. And record the corresponding data; (3) the patients were divided into three types of syndrome according to the results of traditional Chinese traditional Chinese medicine (TCM), hearing, asking and cutting diagnosis, divided into three types of syndrome types: blood heat syndrome, blood dryness syndrome and blood stasis syndrome, and the CLSM imaging characteristics of the typical lesions of different syndromes were analyzed and summarized as third parts. CLSM imaging features of normal skin; the second part obtained the features of CLSM image in the skin lesions of patients with psoriasis, and concluded that the skin lesions of psoriasis patients were hyperkeratosis or (and) keratosis, Munro micro abscess, upward extension of dermal papilla, capillary circuitous expansion, hyperemia, psoriasis hyperplasia pattern, basal pigmentation or degeneration, granular layer deficiency. If or thinning, the spinous layer thickened, the inflammatory cells of the dermal papilla infiltrated, and the scattered inflammatory cells were found to change into the main skin structure in the epidermis. The third part showed that the TCM syndrome types of psoriasis were different, and the skin lesions under CLSM were also characterized by different characteristics: Blood heat syndrome was mainly capillary circuitous dilatation and congestion (88.9%), Munr There were three characteristics of O micro abscess (86.1%) and upper dermal papilla (86.1%). Blood dryness syndrome was mainly characterized by excessive keratinization (75%), keratinization (75%) and capillary circuitous dilatation and congestion (75%). Blood stasis syndrome mainly consisted of capillary circuitous dilatation and congestion (100%), Munro micro abscess (85.7%) and diagonalization (85.7%) of three characteristics. Conclusion: confocal laser scanning microscopy (confocal laser scanning microscopy) has some characteristics in the diagnosis of psoriasis. Confocal laser scanning microscopy can be used to make more accurate classification of psoriasis. It is beneficial to strengthen the pertinence of follow-up treatment, help to reduce the probability of misdiagnosis and improve the effective.CLSM examination in situ, noninvasive, in vivo and rapid. The application of the more accurate, like in other diseases in Department of Dermatology diagnosis field will.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R275.9

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