中华皮肤科杂志 ›› 2020, Vol. 53 ›› Issue (8): 634-639.doi: 10.35541/cjd.20190636

• 研究报道 • 上一篇    下一篇

反射性共聚焦显微镜对早期蕈样肉芽肿定位诊断与疗效监测的研究

朱蒙燕1    虞闻仲1    王平2    刘娇2    黎钊2    戴辉2    许爱娥2   

  1. 1浙江中医药大学附属杭州第三医院皮肤科  310009；2杭州市第三人民医院皮肤科  310009
  • 收稿日期:2019-06-03 修回日期:2019-12-19 发布日期:2020-07-31
  • 通讯作者: 王平 E-mail:dermwang@aliyun.com
  • 基金资助:
    浙江省公益技术研究社会发展项目（2016C33206）；浙江省医药卫生科技计划项目（2014KYB200）；杭州市医药卫生科技项目（0020190705）

Performance of reflectance confocal microscopy in localization diagnosis of and monitoring of therapeutic efficacy in early-stage mycosis fungoides

Zhu Mengyan1, Yu Wenzhong1, Wang Ping2, Liu Jiao2, Li Zhao2, Dai Hui2, Xu Ai′e2   

  1. 1Department of Dermatology, Third People′s Hospital of Hangzhou Affiliated to Zhejiang Chinese Medical University, Hangzhou 310009, China; 2Department of Dermatology, Third People′s Hospital of Hangzhou, Hangzhou 310009, China
  • Received:2019-06-03 Revised:2019-12-19 Published:2020-07-31
  • Contact: Wang Ping E-mail:dermwang@aliyun.com
  • Supported by:
    Zhejiang Public Welfare Technology Research and Social Development Project （2016C33206）; Zhejiang Medical and Health Science and Technology Plan Project（2014KYB200）; Medical and Health Technology Project of Hangzhou（0020190705）

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摘要： 【摘要】 目的 分析早期蕈样肉芽肿（MF）皮损的反射性共聚焦显微镜（RCM）与组织病理学特征的一致性，探讨RCM作为病理学诊断早期MF的辅助价值及动态监测治疗反应的可行性。方法 2014年1月至2018年1月在杭州市第三人民医院皮肤科门诊收集临床疑诊MF病例40例，男26例，女14例，年龄（47.0 ± 17.6）岁。根据总结的早期MF的RCM特征，对活检部位进行初步定位后行组织病理学检查，对比MF的RCM与病理特征。对MF确诊病例进行窄谱中波紫外线联合干扰素治疗，运用RCM对靶向皮损跟踪随访，9个月后评价疗效。结果 在40例临床疑诊MF病例中，根据RCM特征初步诊断典型MF 8例，疑似MF18例，排除14例；根据MF病理学特征诊断典型MF12例，疑似14例，排除14例。一致性分析显示，RCM特征分类与病理诊断结果的Kappa系数为0.848，P < 0.01。RCM与组织病理学特征之间表皮低折光细胞浸润的相关性最高（Kappa系数 = 1，P = 0.005），其次是红斑期的真皮纤维化（Kappa系数 = 0.714，P = 0.035）。MF的RCM特征随着治疗的进行逐步恢复正常，但直至临床皮损完全缓解，非典型淋巴细胞依然存在。结论 RCM技术可用于早期疑诊MF皮损的病理取材定位，同时可尝试作为一种动态监测MF疗效的方法。

关键词: 蕈样真菌病, 显微镜检查, 共焦, 诊断, 治疗结果, 监测

Abstract: 【Abstract】 Objective To analyze consistency between histopathological and reflectance confocal microscopy (RCM) characteristics of early-stage mycosis fungoides（MF）, and to evaluate the value of RCM in assisting the pathological diagnosis of early-stage MF and the feasibility of dynamic monitoring of treatment response with RCM. Methods From January 2014 to January 2018, 40 cases of clinically suspected MF were collected from Department of Dermatology, Third People′s Hospital of Hangzhou, including 26 males and 14 females, and their age was 47.0 ± 17.6 years. According to the summarized RCM characteristics of early-stage MF, biopsy sites were preliminarily located, and then a histopathological examination was performed. The RCM and pathological features of MF were compared. In addition, a combination therapy with narrowband ultraviolet B and interferon was performed in patients with confirmed MF. Targeted lesions were followed up with RCM for 9 months, and then therapeutic efficacy was evaluated. Results Among the 40 cases of clinically suspected MF, 8 were preliminarily diagnosed as typical MF, 18 as suspected MF, and 14 were excluded according to the RCM characteristics; according to the pathological features, 12 could be diagnosed as typical MF, 14 as suspected MF, and 14 were excluded. Consistency analysis showed that the kappa coefficient between RCM classification and pathological diagnosis was 0.848（P < 0.01）. The consistency of epidermal infiltration of mildly refractive cells was the highest between RCM and pathological findings （kappa coefficient = 1, P = 0.005）, followed by dermal fibrosis at the erythema stage （kappa coefficient = 0.714, P = 0.035）. The RCM characteristics of MF gradually returned to normal during treatment, but atypical lymphocytes still existed when clinical lesions completely regressed. Conclusion RCM can be used for pathological localization of suspected MF lesions in the early stage, and for dynamic monitoring of therapeutic efficacy in MF.

Key words: Mycosis fungoides, Microscopy, confocal, Diagnosis, Treatment outcome, Monitor

引用本文

朱蒙燕 虞闻仲 王平 刘娇 黎钊 戴辉 许爱娥. 反射性共聚焦显微镜对早期蕈样肉芽肿定位诊断与疗效监测的研究[J]. 中华皮肤科杂志, 2020,53(8):634-639. doi:10.35541/cjd.20190636

Zhu Mengyan, Yu Wenzhong, Wang Ping, Liu Jiao, Li Zhao, Dai Hui, Xu Ai′e. Performance of reflectance confocal microscopy in localization diagnosis of and monitoring of therapeutic efficacy in early-stage mycosis fungoides[J]. Chinese Journal of Dermatology, 2020, 53(8): 634-639.doi:10.35541/cjd.20190636