皮肤血管炎163例组织病理及临床分析

Histopathological and clinical analysis of 163 cases of cutaneouos vasculitis

目的:总结163例皮肤血管炎组织病理和临床特点,指导临床诊疗。方法:采用回顾分析的方法对163例皮肤血管炎患者的皮损组织病理及临床资料作分析总结。结果:163例患者中男64例,女99例,平均年龄39.8岁,平均病程3.68年。与发病有关因素依次为:感染15.9%,系统性免疫性疾病15.9%,季节性因素8.59%,药物3.68%,食物1.84%,劳累0.6%;不明原因52.7%。组织病理分为5型,其中白细胞碎裂性血管炎36.8%,淋巴细胞性血管炎10.43%,节段透明性血管炎1.84%,肉芽肿性血管炎8.59%,血管炎伴脂膜炎[42.3%(69例),其中57例(82.6%)为白细胞碎裂性血管炎]。部分临床表现与组织病理特点有很好的一致性,但时有相左。结论:皮肤血管炎分类复杂,临床表现各异,根据组织病理学特点分型更加准确。白细胞碎裂性血管炎最常见,加上伴脂膜炎的白细胞碎裂性血管炎总共占71.7%,其中有部分临床损害类似脂膜炎,此时需要组织病理检查确诊。组织病理学分型对皮肤血管炎的治疗有指导作用。

Objective： To improve the diagnosis and treatment of cutaneous vasculitis through analyzing the clinical and pathological characteristics of 163 cases, Method： The clinical and pathological data of 163 patients with cutaneous vasculitis were retrospectively analyzed. Results： There were 64 male and 99 female patients, with an average age of 39.8 years and the disease-course of 3.68 years on average. The associated predisposing factors were infection （15.9%）, systemic immunological diseases （15.9%）, seasonal factor （8.59%）, medicines （3.68%）, food （1.84%） and tiredness （0.6%）. The cause of more than half （52.7%） of the patients was unknown. Histopathology of skin specimens could be divided into 5 types： leukocytoclastic vasculitis （60 cases, accounting for 36.8%）, lymphocytic vasculitis （17, 10.43%）, granulomatous vasculitis （14, 8.59%）, segmental hyalinizing vasculitis （3, 1.84%）, and vasculitis complicated with panniculitis （69, 42.3%）, fifty-seven patients of the latter （82.6%） were leukoeytoclasitic vasculitis. The clinical manifestations were consistent with the pathological features in some but not with all the cases. Conclusion： Leukocytoclastic vasculitis is most common in these cases, accounting for 71.7%, some were accompanied by panniculitis and mimicked pannieulitis clinically. The histopathological examination is needed in this situation for the final diagnosis and proper treatment.