中华皮肤科杂志 ›› 2018, Vol. 51 ›› Issue (10): 741-744.doi: 10.3760/cma.j.issn.0412-4030.2018.10.008

• 研究报道 • 上一篇    下一篇

银屑病313例临床与组织病理分析

张同梅,王刚   

  1. 710032西安，第四军医大学西京皮肤医院
  • 收稿日期:2018-04-24 修回日期:2018-06-08 出版日期:2018-10-15 发布日期:2018-10-03
  • 通讯作者: 王刚 E-mail:xjwgang@fmmu.edu.cn
  • 基金资助:
    国家临床重点专科建设项目；陕西省科技计划项目（2016LCZX-06）；陕西省科技统筹创新工程计划项目（2016KTZDSF02-05）；陕西省社会发展科技攻关项目（2016SF-374）

Clinical and histopathological analysis of 313 cases of psoriasis

Zhang Tongmei, Wang Gang   

  1. Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi′an 710032, China
  • Received:2018-04-24 Revised:2018-06-08 Online:2018-10-15 Published:2018-10-03
  • Contact: Wang Gang E-mail:xjwgang@fmmu.edu.cn
  • Supported by:
    National Clinical Key Subject Construction Project; Science and Technology Planning Project of Shaanxi Province of China （2016LCZX-06）; Science and Technology Coordination and Innovation Project of Shaanxi Province （2016KTZDSF02-05）; Shaanxi Provincial Science and Technology Project for Social Development （2016SF-374）

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摘要： 目的 分析以皮肤表现为主的6型银屑病的临床表现和组织病理学特征。方法 回顾分析2013—2017年西京皮肤医院收治的313例银屑病患者的临床和组织病理资料。结果 滴状银屑病31例，主要诱因为上呼吸道感染。斑块状银屑病60例，主要诱因有上呼吸道感染、劳累、寒冷等。红皮病性银屑病42例，主要诱因为系统使用糖皮质激素的撤药。泛发性脓疱性银屑病60例，诱因有上呼吸道感染、妊娠、药物等。掌跖脓疱病60例，大部分无明确诱因。连续性肢端皮炎60例，大部分无明确诱因。6型银屑病具有相似的典型病理表现，包括角化不全、Munro微脓疡和/或Kogoj海绵状脓疡、颗粒层变薄或消失、表皮银屑病样增生、真皮乳头血管扩张、淋巴细胞浸润等。所有病例中98例（31%）出现不典型病理表现，其中滴状4例（13%），斑块状3例（5%），红皮病性12例（29%），泛发性脓疱性41例（68%），掌跖脓疱病12例（20%），连续性肢端皮炎26例（43%），包括浆液渗出、表皮不规则增生、非中性粒细胞性海绵水肿、角质形成细胞坏死、真皮中性粒细胞浸润、真皮嗜酸性粒细胞浸润等。结论 各型银屑病具有不同的临床表现和相似的典型组织病理学表现，不典型病理表现的出现可干扰疾病诊断，需要在鉴别诊断时予以重视。

关键词: 银屑病, 回顾性研究, 临床表现, 组织病理

Abstract: Objective To analyze clinical manifestations and histopathological features of 6 subtypes of psoriasis presenting mainly as skin manifestations. Methods Clinical and histopathological data were collected from 313 patients with psoriasis in the Department of Dermatology of Xijing Hospital between 2013 and 2017, and analyzed retrospectively. Results Among the 313 patients, there were 31 patients with guttate-type psoriasis mainly induced by upper respiratory tract infections， 60 with plaque psoriasis with the main precipitating factors being upper respiratory tract infections, overexertion, cold weather and so on, 42 with erythrodermic psoriasis induced mainly by the withdrawal of systemic glucocorticoids, 60 with generalized pustular psoriasis with the main precipitating factors being upper respiratory tract infections, pregnancy, drugs and so on, 60 with palmoplantar pustulosis without definite precipitating factors, and 60 with acrodermatitis continua without definite precipitating factors. The 6 subtypes of psoriasis had similar typical pathological manifestations, including parakeratosis, Munro′s microabscess and/or spongiform pustules of Kogoj, thinning or absence of the granular layer, psoriasis-like epidermal hyperplasia, capillary ectasia in the dermal papillae, lymphocytic infiltration and so on. Atypical pathological manifestations were observed in 98 （31%） of the 313 patients, which included 4 with guttate type psoriasis （13%）, 3 with plaque psoriasis （5%）, 12 with erythrodermic psoriasis （29%）, 41 with generalized pustular psoriasis （68%）, 12 with palmoplantar pustulosis （20%） and 26 with acrodermatitis continua （43%）. These atypical pathological manifestations included serous fluid exudation, irregular epidermal hyperplasia, non-neutrophilic spongiosis, keratinocyte necrosis, dermal neutrophilic infiltration and dermal eosinophilic infiltration. Conclusions Different subtypes of psoriasis have different clinical manifestations and similar typical histopathological features. Atypical pathological features can interfere with the diagnosis of psoriasis, and attention should be paid to the differential diagnosis.

Key words: Psoriasis, Retrospective studies, Clinical manifestation, Histopathology