中华皮肤科杂志 ›› 2012, Vol. 45 ›› Issue (9): 620-623.

• 论著 • 上一篇    下一篇

纵行黑甲良恶性鉴别诊断相关因素分析

门月华1,涂平2,李航2,李雪迎3,陈喜雪4,武玲慎5,李薇薇6,王艺萌6,杨淑霞2,李挺7,傅强8   

  1. 1. 北京大学第三医院
    2. 北京大学第一医院皮肤科
    3. 北大医院统计室
    4. 北京医科大学第一医院皮肤科
    5. 北京大学第一医院皮肤性病科
    6. 北京大学第一医院
    7. 北京大学第一医院病理科
    8. 青海省红十字医院皮肤科
  • 收稿日期:2011-09-23 修回日期:2012-03-07 出版日期:2012-09-15 发布日期:2012-08-31
  • 通讯作者: 李航 E-mail:lihangde@yahoo.com.cn

Determination of clinical parameters for the differential diagnosis of malignant and benign longitudinal melanonychia

  • Received:2011-09-23 Revised:2012-03-07 Online:2012-09-15 Published:2012-08-31

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摘要：

目的 根据纵行黑甲患者年龄、纵行黑甲宽度、发病部位等易于获得的量化临床指标，探索判断纵行黑甲良恶性质及其切除必要性的科学依据。方法　回顾分析2000—2010年甲下恶性黑素瘤病例28例，2005—2010年良性纵行黑甲病例62例。统计学分析患者年龄、纵行黑甲宽度、发病部位等，总结良恶性纵行黑甲临床特征的差异，并利用Logistic回归、ROC方法探索可用于鉴别纵行黑甲良恶性质的临床指标。结果　良性纵行黑甲与甲下恶性黑素瘤的确诊年龄中位数分别为23.0岁与52.5岁；发病年龄中位数分别为21.0岁与48.0岁；黑斑宽度中位数分别为3.0 mm与15.0 mm，差异均有统计学意义。累及拇指及拇趾的甲下恶性黑素瘤占所有甲下恶性黑素瘤的77.8%，累及拇指及拇趾的良性纵行黑甲占所有良性纵行黑甲的48.3%，两组差异有统计学意义。应用Logistic回归与ROC方法评价，发病年龄、确诊年龄及黑甲宽度对甲下恶性黑素瘤与良性纵行黑甲具有鉴别诊断价值。结论　不是所有纵行黑甲一经发现就需立即实施有创诊治。发病年龄、确诊年龄、黑甲宽度及发病部位在良恶性纵行黑甲鉴别中有显著意义，且有可能通过建立数学模型指导临床诊治。

关键词: 治疗

Abstract:

Objective To estimate the value of clinical parameters （such as patients′ age, longitudinal melanonychia width and location） for the differential diagnosis of malignant and benign longitudinal melanonychia as well as for the evaluation of the necessity for invasive management. Methods A retrospective study was performed on 28 cases of subungual malignant melanoma collected from 2000 to 2010 as well as on 62 cases of benign longitudinal melanonychia from 2005 to 2010. Clinical analysis was carried out to compare the differences in clinical parameters such as patients′ age, longitudinal melanonychia width and lesional location, between the malignant melanoma and benign longitudinal melanonychia cases. Logistic regression analysis and ROC method were used to determine valuable clinical parameters for the differential diagnosis of malignant and benign longitudinal melanonychia. Results Significant differences were observed in the median age at diagnosis （23.0 years vs. 52.5 years, Z = 5.44, P < 0.01）, age at onset （21.0 years vs. 48.0 years, Z = 4.70, P < 0.01）, and longitudinal melanonychia width （3.0 mm vs. 15.0 mm, Z = 5.69, P < 0.01） between the patients with malignant melanoma and benign longitudinal melanonychia. The involvement of thumb and hallux was observed in 77.8% of the subungual melanoma cases, and 48.3% of the benign cases （?字2 = 6.57, P < 0.05）. ROC method and Logistic regression analysis indicated that the age at onset and diagnosis as well as width of longitudinal melanonychia were of diagnostic value for the differential diagnosis of malignant and benign longitudinal melanonychia. Conclusions Not all longitudinal melanonychia cases need an invasive management at the time of awareness. The age at onset and diagnosis, width of melanonychia and site of the onset appear to be valuable in the differential diagnosis of malignant and benign longitudinal melanonychia, and there is a possibility to guide clinical diagnosis and treatment by establishing a mathematical model with these parameters.

Key words: Treatment