扁平苔藓36例分析

Analysis on 36 cases of lichen planus

目的：分析36例扁平苔藓（LP）的临床、组织病理（HP）、免疫病理（IF）、免疫印迹特点。方法：回顾分析36例LP的临床资料，HP、IF、免疫印迹检查结果。结果：36例LP中男18例，女18例，年龄12—63岁，病程1周至20年。HP诊断LP的敏感性是72．5％，一些特殊类型如色素性LP、光化性LP、肥厚性LP、毛发LP、大疱性LP、LE／LP重叠综合征等各有其特点。IF诊断LP的敏感性是75％，在IF中，Ig、C3各有11例和10例在基底膜带（BMZ）沉积，其中2例血清中检测出抗BMZ抗体。免疫印迹检查中，在表皮提取的抗原上4例类天疱疮样扁平苔藓（LPP）均出现阳性反应条带，其中2例240kDa，2例200kDa，3例180kDa。结论：LP并非少见，其临床类型很多，HP和IF检查是确诊LP的主要依据。泼尼松、氨苯砜、反应停联合治疗LP有肯定效果。

Objective： To characterize the clinical, histopathological, immunopathological and immunoblotting features of 36 patients with lichen planus （LP）. Methods： The clinical manifestations and histopathological, immunopathologieal, immunoblotting results of the 36 LP patients were analyzed retrospectively. Results： Among the 36 patients,18 were male and 18 were female. The duration of the disease from 1 week to 20 years. The sensitivity of histopathology for LP was 72.5 %. The pathological characteristics of several variants of LP（including LP pigmentosus, actinic LP, hypertrophic LP, follicular LP, bullous LP, LE/LP overlap syndrome） were discussed separately. The sensitivity of immunopathology for LP was 75 %. Deposition of Ig and C3 was observed along the basal membrance zone （BMZ） in 11 patients and 10 patients, respectively. Two of these patients showed circulating IgG antibody. Western blotting of epidermal extracts with sera from 4 patients with lichen planus pemphigoides （LPP） showed a unique band including 200 kDa （2 cases）, 180 kDa （3 cases） and 240 kDa （2 cases）. Conclusion： LP is not an uncommon disease with many clinical variants. The main diagnostic methods for LP were histopathology and immunopathology. Prednisone, dapsone and thalidomide were of great value in the treatment of LP.