中华皮肤科杂志 ›› 2026, Vol. 59 ›› Issue (9): 873-880.doi: 10.35541/cjd.20260231

• 论著·免疫介导炎症性皮肤病 • 上一篇    下一篇

反射式共聚焦显微镜在皮肤型红斑狼疮诊断与鉴别诊断中的价值及特征分析

唐祯1    刘宇航1    杨凌2    胡凌雪1    贺治杰1    曹凯1    丁澍1   

  1. 1中南大学湘雅三医院皮肤科，长沙410013；2湖南省龙山县人民医院皮肤科，龙山416800
  • 收稿日期:2026-04-27 修回日期:2026-07-30 发布日期:2026-09-03
  • 通讯作者: 丁澍 E-mail:226402332@qq.com
  • 基金资助:
    湖南省自然科学基金（2023JJ20090）；湖南省科技创新计划项目芙蓉计划湖湘青年英才（2023RC3086）；湖南省卫生健康委科研计划项目（202304129002）；中南大学创新驱动计划（2023CXQD074）；中南大学湘雅三医院汇智育才计划（YX202101）；中南大学学位与研究生教育教学改革研究项目（512330034）

Value and features of reflectance confocal microscopy in the diagnosis and differential diagnosis of cutaneous lupus erythematosus

Tang Zhen¹, Liu Yuhang¹, Yang Ling², Hu Lingxue¹, He Zhijie¹, Cao Kai¹, Ding Shu¹   

  1. ¹Department of Dermatology, the Third Xiangya Hospital of Central South University, Changsha 410013, China; ²Department of Dermatology, Longshan County People's Hospital, Longshan 416800, China
  • Received:2026-04-27 Revised:2026-07-30 Published:2026-09-03
  • Contact: Ding Shu E-mail:226402332@qq.com
  • Supported by:
    Natural Science Foundation of Hunan Province（2023JJ20090）; Science and Technology Innovation Program of Hunan Province ?Furong Plan of Huxiang Young Talents （2023RC3086）; Scientific Research Project of the Hunan Provincial Health Commission （202304129002）; Innovation-driven Program of Central South University （2023CXQD074）; Wisdom Accumulation and Talent Cultivation Project of the Third Xiangya Hospital of Central South University （YX202101）; General Project of Graduate Education and Teaching Reform Research of Central South University （512330034）
    DOI: 10.35541/cjd.20260231

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摘要： 【摘要】 目的 探讨反射式共聚焦显微镜（RCM）在皮肤型红斑狼疮（CLE）诊断及鉴别诊断中的应用价值。方法 回顾性收集2020年1月至2025年12月中南大学湘雅三医院皮肤科门诊临床拟诊CLE患者169例，均行RCM检查及皮损组织病理检查。以组织病理检查结果为金标准，计算RCM诊断的灵敏度、特异度及准确率。总结盘状红斑狼疮（DLE）、亚急性CLE、急性CLE的RCM特征，并探讨与扁平苔藓、光线性角化病、环状肉芽肿、皮肌炎、银屑病、脂溢性皮炎的鉴别要点。结果 169例临床拟诊的CLE患者中，病理确诊84例（49.7%）；75例（44.4%）经RCM诊断为CLE，其中68例与组织学诊断一致。RCM诊断CLE的灵敏度为80.95%（95% CI：71.70% ~ 88.00%），特异度为91.76%（95% CI：83.80% ~ 96.30%），准确率为86.39%（95% CI：81.20% ~ 91.60%），Kappa值为0.73（95% CI：0.58 ~ 0.87）。CLE与其他疾病鉴别的核心RCM特征包括真表皮分界不清、基底细胞液化变性、真皮浅层血管或毛囊周围炎症反应；DLE以角化过度、毛囊角栓、真皮内血管及毛囊周围噬色素细胞及炎症细胞浸润突出为RCM特征；亚急性CLE以表皮萎缩变薄、真皮内血管扩张充血、管周炎症细胞浸润明显为RCM特征；急性CLE的RCM特征为毛囊角栓、真皮浅层水肿、血管扩张充血及管周炎症细胞浸润。结论 RCM对CLE诊断效能良好，能为常见CLE亚型的诊断及与相似疾病的鉴别诊断提供影像学线索，可作为CLE临床诊断的重要辅助工具。

关键词: 红斑狼疮, 皮肤, 反射式共聚焦显微镜, 红斑狼疮, 盘状, 诊断, 鉴别诊断

Abstract: 【Abstract】 Objective To evaluate the diagnostic and differential diagnostic value of reflectance confocal microscopy （RCM） for cutaneous lupus erythematosus （CLE）. Methods A total of 169 patients with clinically suspected CLE were retrospectively enrolled from the Department of Dermatology, the Third Xiangya Hospital of Central South University between January 2020 and December 2025. All patients underwent both RCM and histopathological examinations. Using histopathological findings as the gold standard, the sensitivity, specificity, and accuracy of RCM for diagnosing CLE were calculated. The RCM features of discoid lupus erythematosus （DLE）, subacute CLE （SCLE）, and acute CLE （ACLE） were summarized, and key features differentiating CLE from lichen planus, actinic keratosis, granuloma annulare, dermatomyositis, psoriasis, and seborrheic dermatitis were analyzed. Results Among the 169 patients with clinically suspected CLE, 84 （49.7%） were pathologically confirmed; 75 （44.4%） were diagnosed with CLE by RCM, of whom 68 showed concordance between RCM and histopathological diagnosis. The sensitivity, specificity, and accuracy of RCM for diagnosing CLE were 80.95% （95% CI: 71.70% - 88.00%）, 91.76% （95% CI: 83.80% - 96.30%）, and 86.39% （95% CI: 81.20% - 91.60%）, respectively, with a kappa coefficient of 0.73 （95% CI: 0.58 - 0.87）. The core RCM features distinguishing CLE from other diseases included the indistinct dermo-epidermal junction, liquefaction degeneration of the basal cell layer, and perivascular or perifollicular inflammatory infiltration in the superficial dermis. In addition, RCM revealed that DLE was characterized by hyperkeratosis, follicular plugging, and prominent infiltration of melanophages and inflammatory cells around dermal vessels and hair follicles; SCLE was characterized by epidermal atrophy and thinning, dermal vascular dilatation and congestion, and marked perivascular inflammatory infiltration; ACLE was characterized by follicular plugging, superficial dermal edema, dermal vascular dilatation and congestion, and perivascular inflammatory infiltration. Conclusion RCM demonstrated favorable diagnostic performance for CLE, could provide imaging clues for the diagnosis of common CLE subtypes and their differentiation from mimicking conditions, and may serve as a valuable adjunctive tool in the clinical diagnosis of CLE.

Key words: Lupus erythematosus, cutaneous, Reflectance confocal microscopy, Lupus erythematosus, discoid, Diagnosis, Differential diagnosis

引用本文

唐祯 刘宇航 杨凌 胡凌雪 贺治杰 曹凯 丁澍. 反射式共聚焦显微镜在皮肤型红斑狼疮诊断与鉴别诊断中的价值及特征分析[J]. 中华皮肤科杂志, 2026,59(9):873-880. doi:10.35541/cjd.20260231

Tang Zhen¹, Liu Yuhang¹, Yang Ling², Hu Lingxue¹, He Zhijie¹, Cao Kai¹, Ding Shu¹. Value and features of reflectance confocal microscopy in the diagnosis and differential diagnosis of cutaneous lupus erythematosus[J]. Chinese Journal of Dermatology, 2026, 59(9): 873-880.doi:10.35541/cjd.20260231