共聚焦激光扫描显微镜观察寻常性银屑病120例

In vivo imaging of lesions of psoriasis vulgaris with confocal laser scanning microscopy

目的 利用皮肤共聚焦激光扫描显微镜（CLSM）技术观察寻常性银屑病的成像特征.方法 寻常性银屑病患者120例,选择典型皮损做激光共聚焦显微镜检查,记录各项指标的扫描结果.结果 120例寻常性银屑病患者均存在真皮乳头毛细血管迂曲扩张,113例（94.17％）棘层增厚,106例（88.33％）角化不全,86例（71.67％）角质层内可见Munro微脓肿,71例（59.17％）颗粒层减少或消失.27例滴状银屑病,真皮乳头内可见1～2个增生的毛细血管管腔,真皮乳头间距离未见缩小；24例基底层色素环轻度减退或部分缺失；其棘层厚度为（96.85±17.88） μm（80 ～ 150 μm）.29例斑块状银屑病真皮乳头内毛细血管明显扩张充血,其血管形态呈特征“S”形、马蹄形；真皮乳头直径扩大,乳头间距离缩小,局部可见典型的藕片样结构；25例基底层色素环完全缺失,其棘层厚度为（143.45±23.19） μm（100 ～ 190 μm）,明显高于滴状银屑病.结论 CLSM的成像特征可能为寻常性银屑病的诊断提供帮助.

Objective To observe the lesions of psoriasis vulgaris by confocal laser scanning microscopy （CLSM）.Methods The typical lesions of 120 patients with psoriasis vulgaris were observed by CLSM,and scanning results were recorded.Results Of the 120 patients with psoriasis vulgaris,all （100%）had dilated and twisted capillaries in dermal papillae,113 （94.17%） acanthosis,106 （88.33%） parakeratosis,86 （71.67%） Munro microabscesses at the level of stratum corneum,71 （59.17%） diminished or disappeared stratum granulosum.There were a few （1 to 2） dilated capillary lumens in papillary dermis,with no obvious reduction in the distance between dermal papillae.Some dermal papillary rings lost their integrity or brightness slightly in 24 of the 27 patients with psoriasis guttata.The height of stratum spinosum was 96.85 ± 17.88 μm （ranged：80-150 μm） in patients with psoriasis guttata,lower than that in those with plaque psoriasis （average：143.45 ± 23.19 μm,range：100-190 μm）.In lesions of plaque psoriasis,the capillaries in dermal papillae were apparently dilated with hyperemia,showing a characteristic ＇S＇ shape or horseshoe appearance; the diameter of dermal papillae was increased and the distance between dermal papillae was reduced,giving a ＇transverse section of lotus roots＇ appearance.Dermal papillary rings completely disappeared in 25 of the 29 patients with plaque psoriasis.Conclusion CLSM may serve as an aid in the diagnosis of psoriasis vulgaris.