【摘要】：目的探討砷角化病患者的皮膚臨床表現(xiàn)、實(shí)驗(yàn)室檢查、病理學(xué)檢查特點(diǎn)、治療及轉(zhuǎn)歸。方法收集2010年3月—2015年1月天津市第三中心醫(yī)院收治的砷角化病患者20例為研究對(duì)象,回顧性分析其皮膚臨床表現(xiàn)、實(shí)驗(yàn)室檢查、病理學(xué)檢查結(jié)果、治療及轉(zhuǎn)歸并復(fù)習(xí)相關(guān)文獻(xiàn)。結(jié)果 20例患者中14例患者出現(xiàn)掌跖角化過(guò)度,12例患者軀干四肢出現(xiàn)散在點(diǎn)狀、疣狀、皮角樣、角化斑片樣皮損,其中6例出現(xiàn)鮑溫病、6例出現(xiàn)鱗狀細(xì)胞癌、2例出現(xiàn)反復(fù)難愈性皮膚潰瘍,11例患者出現(xiàn)皮膚疣狀增生物,8例患者全身皮膚顏色加深,6例患者指、趾甲變色,部分伴有白色橫紋,6例患者出現(xiàn)瘙癢、針刺樣疼痛等癥狀,3例患者出現(xiàn)口腔潰瘍,4例患者出現(xiàn)其他系統(tǒng)癥狀;18例血砷及尿砷水平均升高,3例患者血小板計(jì)數(shù)(PLT)下降,2例患者血肌酐水平升高;掌跖角化區(qū)域皮損病理學(xué)檢查可出現(xiàn)多樣性變化;二巰基丙磺酸鈉、阿維A治療有效,伴發(fā)鮑溫病及鱗狀細(xì)胞癌患者行Mohs'顯微外科手術(shù)治療,復(fù)發(fā)率較低。結(jié)論砷角化病患者少見(jiàn)且接觸途徑多樣,皮損特點(diǎn)及皮膚臨床表現(xiàn)多樣化,實(shí)驗(yàn)室檢查具有特異性,診斷主要依靠病史詢問(wèn)、皮膚臨床表現(xiàn)及實(shí)驗(yàn)室檢查;藥物聯(lián)合手術(shù)治療預(yù)后較佳。
[Abstract]:Objective to investigate the clinical manifestation, laboratory examination, pathological features, treatment and outcome of arsenic keratosis. Methods from March 2010 to January 2015, 20 patients with arsenical keratosis who were admitted to Tianjin third Central Hospital from March 2010 to January 2015 were collected. The results of clinical manifestation, laboratory examination and pathological examination of the skin were analyzed retrospectively. Treatment and outcome and review of relevant literature. Results among the 20 cases, 14 cases showed palmoplantar hyperkeratosis, 12 cases showed scattered spot, verrucous, keratoid, keratotic patchy lesions in the trunk and limbs, 6 cases had Bowen's disease and 6 cases had squamous cell carcinoma. There were 2 cases with recurrent refractory skin ulcers, 11 cases with verrucous skin hyperplasia, 8 cases with deep skin color, 6 cases with finger and toenail discoloration, some with white cross striae, 6 cases with pruritus. The symptoms of acupuncture-like pain were 3 cases with oral ulcer and 4 cases with other systemic symptoms. Blood arsenic and urine arsenic increased in 18 cases, platelet count (PLT) decreased in 3 cases, serum creatinine level increased in 2 cases, the pathological changes of the lesions in palmoplantar keratosis area showed diversity changes, while platelet count decreased in 3 cases and serum creatinine level increased in 2 cases. The treatment of sodium dimercaptopropionate and acitretin was effective. Mohs' microsurgical treatment was performed in patients with Bowen's disease and squamous cell carcinoma. The recurrence rate was lower. Conclusion the patients with arsenical keratosis are rare and have various ways of contact, the characteristics of skin lesions and clinical manifestations of the skin are diverse, the laboratory examination is specific, the diagnosis mainly depends on the inquiry of the history, the clinical manifestation of the skin and the laboratory examination. The prognosis of combined operation was better.
【作者單位】： 天津市第三中心醫(yī)院皮膚科;天津中醫(yī)藥研究院附屬醫(yī)院病理科;天津市第三中心醫(yī)院病理科;
【分類號(hào)】：R751

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