本文關鍵詞：尋常型銀屑病皮膚鏡特征及皮損變化與血管關系的研究　出處：《天津醫(yī)科大學》2015年碩士論文　論文類型：學位論文

  更多相關文章： 皮膚鏡 尋常型銀屑病 血管 診斷 治療

【摘要】：皮膚鏡(Dermoscopy)是一種直接在體觀察皮膚各種微小結構、血管和色素改變等特征的無創(chuàng)性顯微圖像分析技術。皮膚鏡可以觀察到表皮、真皮乳頭層和真皮深層等肉眼無法看到的影像結構與特征,這些特征在臨床上與疾病在組織病理學的變化有著很大的對應關系,圖像特征和病理的相互對應關系確定了皮膚鏡疾病診斷的敏感性和特異性。目前,國內皮膚鏡主要應用于色素性皮膚病方面,大大減少了以往對色素性皮損肉眼診斷的誤診率,并且皮膚鏡的無創(chuàng)性避免了部分患者被盲目活檢或因直接外科手術切除而造成的不必要的創(chuàng)傷。對于非色素性炎癥性皮膚病,皮膚鏡也可以通過研究皮損部位血管形態(tài),分布模式、密度和其他特征進行鑒別和診斷,但國內研究較少,尚沒有一個成熟的標準。銀屑病(Psoriasis)是皮膚科臨床一種常見、反復發(fā)生、與免疫相關的慢性炎癥性皮膚病。本病發(fā)病率較高。其臨床不典型病例確診依據(jù)主要依靠病理診斷,痛苦性大,患者不易接受。無創(chuàng)性的檢查方法越來越得到患者和醫(yī)院的認可。目的:探討尋常型銀屑病各部位(軀干、面部、頭皮、黏膜、指甲、掌趾)皮損的皮膚鏡特征及其診斷意義;皮膚鏡動態(tài)觀察銀屑病有效治療后皮損血管的改變及其與皮損改變的相關性。方法:1.選取120例尋常型銀屑病患者,使用皮膚鏡研究其背景顏色、鱗屑顏色、低倍鏡和高倍鏡下血管形態(tài)、血管排列模式和血管走行方向,并統(tǒng)計其頻率,所有數(shù)據(jù)均經(jīng)SPSS10.0軟件進行統(tǒng)計分析,統(tǒng)計各種圖像的陽性率,描述各項指標靈敏度。2.選取30例持續(xù)治療的銀屑病患者于治療0、1、2、3、4、6周使用皮膚鏡做皮損處血管變化的動態(tài)連續(xù)性觀察,并于同一時間對同一皮損做紅斑、鱗屑、浸潤的評分并記錄,比較皮損血管變化及與皮損變化的關系。結果:1.尋常型銀屑病主要皮膚鏡特征主要為低倍鏡下紅色背景、銀白色鱗屑、血管規(guī)則排列模式、點/球狀血管和高倍下腎小球樣血管,其中頭皮部位高倍鏡下以腎小球樣血管和非典型血管為主;黏膜改變未觀測到明顯鱗屑。掌趾部位圖像特征低倍鏡下紅色背景、銀白色鱗屑、低倍下點/球狀血管沿皮嵴呈線狀均勻規(guī)則排列、高倍下腎小球樣血管;甲改變主要表現(xiàn)為甲板可見多發(fā)性小坑、遠端甲剝離,線狀出血,鮭魚補丁;甲小皮可見迂曲擴張血管呈不規(guī)則分布; 近端甲皺血管形態(tài)改變,無明顯模式。2.a.銀屑病有效治療后,皮損處血管往正�；貧w,血管直徑變小,血管球截面積變小。b.療效相對指數(shù)與血管相對指數(shù)、療效相對指數(shù)評分與血管球相對指數(shù)評分隨時間變化的變化趨勢為0-4周增加,4-6周降低。c.療效相對指數(shù)及血管相對指數(shù)呈正相關,R=0.914,p0.01,具有統(tǒng)計學意義。d.療效相對指數(shù)評分及血管球相對指數(shù)評分呈正相關,R=0.894,p0.01,具有統(tǒng)計學意義。結論:1.本次研究顯示,皮膚鏡下尋常型銀屑病血管及鱗屑等模式,可用于臨床輔助鑒別和診斷。2.銀屑病皮損變化與血管直徑、血管球截面變化呈正相關,提示皮損血管變化觀察可用于銀屑病恢復情況及藥物療效的觀察。
[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.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R758.63

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