获得性非真菌性甲病的临床与病理特征分析

Clinical and pathological characteristics of acquired nonfungal onychopathy

目的通过甲单位病理确诊不明原因的获得性非真菌性甲病，探讨不同甲病与甲损害类型间有无关联。方法对临床上无任何皮肤、黏膜损害，甲真菌学检查阴性的52例甲病患者，首先根据甲损害特征分类，通过纵行甲活检手术方法取材进行甲单位病理检查。然后将确诊的不同甲病与甲损害的特征相比较。结果病理确诊甲银屑病14例，以脆甲、厚甲、点状凹陷等多见。甲扁平苔藓21例，甲损害分为两大类，第一类为甲萎缩、甲胬肉和无甲；第二类为甲纵嵴、远端甲裂和薄甲。甲非特异性湿疹样变17例，损害主要有沙纸样甲和甲纵嵴。结论某些类型的甲板损害与甲单位病理诊断之间存在着关联性，了解这些特点对获得性非真菌陛甲病的临床诊断、鉴别诊断提供参考依据。

Objective To make a definite diagnosis of acquired nonfungal onychopathy of unclear origin via histopathological examination on nail units, and to assess the relationship between onychopathy and type of nail damage. Methods A total of 52 patients with onychopathy but without cutaneous or mucosal manifestations were included in this study. Mycological examination of involved nails was negative in all patients. Histopathological examination was performed on nail units following longitudinal nail biopsy. Results Fourteen cases were diagnosed as nail psorsiasis （NP）, which was commonly manifested as pitted nail, onychorrhexis and thick nail. Nail lichen planus （NLP） was diagnosed in 21 patients, who presented with two categories of nail damage; one category included onychatrophy, pterygium unguis and anonychia, the other one included nail distal splitting, nail longitudinal ridging and thin nail. Seventeen cases showed non-specific eczematous changes, and the most common manifestations were sandpaper nail and nail longitudinal ridging. Conclusions There is some correlation between some types of nail damage and patterns of nail unit pathology. To under- stand this correlation will provide important evidence on clinical diagnosis and differential diagnosis of acquired nonfungal onychopathy.