斑秃皮损的皮肤镜影像及其与临床病理的关系

摘要/Abstract

摘要：

目的探讨皮肤镜下斑秃皮损的微细改变及其与临床、病理相关性。方法使用皮肤镜观察62例斑秃患者和44例其他类型脱发患者的皮损，收集患者临床及实验室资料，并对其中15例斑秃患者进行皮损部位组织病理活检，以了解皮肤镜的组织形态学基础。结果皮肤镜下斑秃影像为黄点征、黑点征、断发、毳毛、新生短发和感叹号样毛发。黄点征发生率最高（83.9%），而诊断斑秃的特异性指标为感叹号样毛发、黑点和断发，且后三者发生率与斑秃的活动性及轻拉发试验阳性率呈显著正相关关系。甲状腺过氧化物酶抗体升高发生率与轻拉发实验阳性率及断发发生率呈显著正相关。黄点征发生率和病理下毛囊口角栓阳性率之间呈显著正相关关系，新生短发发生率和毛囊周围肥大细胞浸润发生率以及黑点发生率则与生长期与退行期毛囊之间比例减少均呈显著负相关关系。结论可以用黄点征作为斑秃诊断的初筛指标，而感叹号样毛发、黑点和断发对于确诊斑秃的特异性较高，且提示患者病情仍处于活动期。斑秃患者皮肤镜影像与病理有一定相关性，可用于判断病情并指导治疗。

关键词: 病理过程

Abstract:

Objective To observe the microstructural changes in lesions of alopecia areata （AA） with dermoscopy and to evaluate their correlation with clinicopathological manifestations. Methods The area of alopecia of 62 patients with AA and 44 patients with other types of hair loss were observed by using a non-contact polarized dermoscope （Dermlite, USA）. Clinical data on and laboratory findings from these patients were collected. Pathological examination was carried out with scalp biopsy specimens from the alopecia area of 15 AA patients. Results Characteristic dermoscopic signs of AA included yellow dots, black dots, broken hairs, exclamation mark hairs, short vellus hair and newly-grown short hairs. Among these signs, yellow dots showed the highest prevalence （83.9%）. Exclamation mark hairs, black dots and broken hairs were rather specific signs for AA, and the prevalence of the three signs was positively correlated with disease activity and positivity rate of hair-pull test. A positive correlation was also noted between the prevalence of elevated thyroid peroxidase antibody levels and positivity rate of hair-pull test （r = 0.269, P < 0.05） as well as prevalence of broken hairs （r = 0.445, P < 0.05）, and between the prevalence of yellow dots and that of keratinous plug in follicular orifice. There was a negative correlation between the prevalence of newly-grown short hairs and perifollicular mast cell infiltration and between the prevalence of black dots and the anagen/catagen ratio. Conclusions Yellow dots can serve as a preliminary screening marker for AA. Exclamation mark hairs, black dots and broken hairs are highly sensitive for the confirmation of diagnosis of AA, and often predict progressive AA. Dermoscopic signs are well correlated to the histopathology features of AA, and may be useful for the evaluation of disease severity and guidance on the treatment of AA.

Key words: Pathologic processes

赵莹蔡泽明巩毓刚西兰杨建陈闻纳章星琪. 斑秃皮损的皮肤镜影像及其与临床病理的关系[J]. 中华皮肤科杂志, 2011, 44(1): 30-34.

参考文献

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