中华皮肤科杂志 ›› 2019, Vol. 52 ›› Issue (2): 103-106.doi: 10.3760/cma.j.issn.0412-4030.2019.02.007

• 研究报道 • 上一篇    下一篇

不同时期黄褐斑皮损三种皮肤影像的形态学分析

陈荣    许爱娥   

  1. 浙江中医药大学杭州第三医院皮肤科 310000
  • 收稿日期:2018-04-02 修回日期:2018-12-10 出版日期:2019-02-15 发布日期:2019-01-29
  • 通讯作者: 许爱娥 E-mail:xuaiehz@msn.com
  • 基金资助:
    国家自然科学基金（81271758、81472887）

Morphological analysis of melasma lesions at different clinical stages by using three different skin imaging techniques

Chen Rong, Xu Ai′e   

  1. Department of Dermatology, The Third Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou 310000, China
  • Received:2018-04-02 Revised:2018-12-10 Online:2019-02-15 Published:2019-01-29
  • Contact: Xu Ai′e E-mail:xuaiehz@msn.com
  • Supported by:
    National Natural Science Foundation of China （81271758, 81472887）

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摘要： 【摘要】 目的 运用三种皮肤影像技术探究女性黄褐斑不同时期皮损的形态。方法 2017年6月至2018年1月，在杭州市第三人民医院门诊收集女性黄褐斑患者253例。结合临床分期标准，应用反射式共聚焦显微镜（RCM）、VISIA皮肤图像检测仪、皮肤镜观察不同时期黄褐斑皮损，分析临床分期与树突状黑素细胞、亚临床黄褐斑、血管形态改变的相关性。采用SPSS19.0统计学软件，计数资料比较采用卡方检验及独立样本Mann?Whitney U检验。结果 253例患者中，进展期100例，稳定期153例。进展期患者中78例（78%）RCM下有树突状黑素细胞，稳定期中22例（14.4%）可见树突状黑素细胞，两组间差异有统计学意义（χ2 = 102.40，P＜0.01）。VISIA皮肤图像检测仪观察显示，进展期患者中78例（78%）有亚临床黄褐斑，稳定期患者25例有亚临床黄褐斑（16.3%），进展期亚临床黄褐斑出现率高于稳定期（χ2 = 95.26，P＜0.01）。皮肤镜显示，进展期患者血管改变发生率为74%（74/100），稳定期为68.6%（105/153），两组差异无统计学意义（χ2 = 0.84，P = 0.39）。结论 RCM、VISIA皮肤图像检测仪下分别观察的树突状黑素细胞及亚临床表现可作为黄褐斑临床分期的参考指标。

关键词: 黄褐斑； 黑素细胞； 显微镜检查, 共焦； 皮肤镜； 临床分期； 皮肤图像检测仪

Abstract: 【Abstract】 Objective To investigate morphological characteristics of female melasma lesions at different clinical stages by using three skin imaging techniques. Methods A total of 253 female outpatients with melasma were enrolled from the Third Affiliated Hospital of Zhejiang Chinese Medicine University between June 2017 and January 2018. According to the clinical staging criteria, melasma lesions at different clinical stages were observed with reflectance confocal microscopy （RCM）, VISIA skin imaging detector and dermoscopy, and correlations of clinical staging with dendritic melanocytes, subclinical melasma and morphological changes of blood vessels were analyzed. Statistical analysis was carried out with SPSS19.0 software by using chi-square test and Mann-Whitney U test for the comparison of enumeration data. Results Of 253 patients with melasma, 100 were with progressive melasma, and 153 with stable melasma. RCM showed that dendritic melanocytes were observed in 78（78%） patients with progressive melasma, as well as in 22（14.4%）patients with stable melasma, and there was a significant difference between the 2 groups （χ2 = 102.40, P < 0.01）. VISIA skin imaging detector showed that subclinical melasma was observed in 78 （78%） patients with progressive melasma, as well as in 25（16.3%） patients with stable melasma, and the prevalance of subclinical melasma was significantly higher in the patients with progressive melasma than in those with stable melasma （χ2 = 95.26, P < 0.01）. Dermoscopy showed that the frequency of morphological changes in blood vessels did not differ between the patients with progressive melasma （74%, 74/100） and those with stable melasma （68.6%, 105/153; χ2 = 0.84, P = 0.39）. Conclusion The dendritic melanocytes and subclinical manifestations under RCM and VISIA skin imaging detector can serve as reference indices for clinical staging of melasma.

Key words: Chloasma, Melanocytes, Microscopy, confocal, Dermoscopy, Clinical stages, Skin imaging detector