本文選題：進(jìn)行性斑狀色素減少癥 + 致病菌　； 參考：《安徽醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 背景:進(jìn)行性斑狀色素減少癥(PMH)是一種較為常見(jiàn)的色素減退性疾病,由Guillet在1988年首次報(bào)道。其典型的臨床特征為發(fā)生于軀干前后、邊界欠清的橢圓形色素減退斑,可于近中線處融合成片狀。常被誤診為其他色素減少性疾病(如花斑癬、炎癥后色素減退等)。到目前為止PMH的病因仍然是不清的。 目的:研究進(jìn)行性斑狀色素減少癥(PMH)的臨床特點(diǎn),并從多個(gè)角度進(jìn)行實(shí)驗(yàn)研究,探究其發(fā)病機(jī)制及總結(jié)該病的診斷要點(diǎn)。同時(shí)對(duì)該病進(jìn)行針對(duì)性治療。 方法:應(yīng)用Wood燈及活體共聚焦激光掃描顯微鏡(皮膚CT)觀察皮損特點(diǎn)、致病菌培養(yǎng)、黑素細(xì)胞培養(yǎng),并應(yīng)用S-100和TRP-1免疫組化分析皮損區(qū)黑素細(xì)胞數(shù)量、電鏡觀察其超微結(jié)構(gòu)特征。 結(jié)果:Wood燈檢查示皮損區(qū)可見(jiàn)點(diǎn)狀紅色熒光,皮膚CT觀察示皮損區(qū)色素環(huán)完整,但與周?chē)Ｆつw相比其內(nèi)所含的黑素顆粒含量減少。致病菌培養(yǎng)可見(jiàn)產(chǎn)紅色熒光的G+棒狀桿菌,經(jīng)鑒定為痤瘡丙酸桿菌。S-100染色示皮損區(qū)陽(yáng)性細(xì)胞數(shù)(8.25±0.96)與周?chē)Ｆつw(8.75±1.71)相比無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);TRP-1染色示皮損區(qū)陽(yáng)性細(xì)胞數(shù)(4.25±0.96)與周?chē)Ｆつw(4.50±1.29)相比也無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);T311染色示皮損區(qū)陽(yáng)性細(xì)胞數(shù)與正常皮膚相比亦無(wú)差異。電鏡觀察發(fā)現(xiàn)皮損區(qū)IV期黑素小體的數(shù)量明顯下降,并觀察到較多的膜結(jié)合體,內(nèi)含成簇狀分布的多個(gè)體積較小的II-IV期黑素小體。成功培養(yǎng)出黑素細(xì)胞,其形態(tài)與正常細(xì)胞相比未見(jiàn)明顯異常。 結(jié)論:根據(jù)我們的臨床及實(shí)驗(yàn)研究,提出了進(jìn)行性斑狀色素減少癥的臨床診斷要點(diǎn)。1)好發(fā)于青年患者,無(wú)家族史。2)皮損以圓形或橢圓形,邊界欠清的色素減退斑為特征,無(wú)鱗屑,且邊緣無(wú)色素沉著,無(wú)感覺(jué)異常。3)主要發(fā)生于背部、腹部,可于近中線處融合成片狀,并可泛發(fā)于頸部、四肢近端等。4)Wood燈下可見(jiàn)色素減退區(qū)存在局限性點(diǎn)狀紅色熒光,皮膚共聚焦激光掃描顯微鏡觀察示皮損區(qū)‘色素環(huán)’正常,但與周?chē)Ｆつw相比其內(nèi)所含的色素顆粒減少。5)皮損區(qū)細(xì)菌培養(yǎng)可培養(yǎng)出痤瘡丙酸桿菌,真菌鏡檢及培養(yǎng)陰性。6)組織學(xué)檢查示皮損區(qū)黑素細(xì)胞數(shù)量無(wú)明顯減少。7)超微結(jié)構(gòu)觀察皮損區(qū)及皮損邊緣外觀正常皮膚內(nèi)可見(jiàn)較多的膜結(jié)合體(內(nèi)含多個(gè)體積較小的II-IV期黑素小體)。過(guò)氧化苯甲酰聯(lián)合NB-UVB是治療進(jìn)行性斑狀色素減少癥的一種有效的方法。
[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 鹵0.96) and that in the surrounding normal skin was 8.75 鹵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 鹵0.96) and in the normal skin around the skin (4.50 鹵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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類(lèi)號(hào)】：R758.4

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