反射式共聚焦显微镜在儿童皮肤扁平苔藓诊断中的应用

Application of reflectance confocal microscopy in the diagnosis of cutaneous lichen planus in children

目的探讨儿童皮肤扁平苔藓反射式共聚焦显微镜（reflectance confocal microscopy，RCM）下影像特征及其在儿童扁平苔藓早期诊断中的意义。方法应用RCM对35例儿童扁平苔藓皮损进行扫描，并在同一位置取材，进行常规组织病理检查，比较RCM影像学特征与组织病理学特征。所有病例均经临床表现与组织病理检查明确诊断。结果35例扁平苔藓患儿的典型RCM图像显示：表皮见细胞水肿形成低折光暗区，可见颗粒层和棘层的清晰过渡，见中度折光的炎症细胞浸润，这些改变对应病理学颗粒层楔形增厚；真表皮交界不清，真皮乳头环模糊或缺失，炎症细胞浸润，围绕交界处大多呈现薄片状结构，这些改变对应病理学界面皮炎的改变；真皮内炎症细胞带状浸润，浸润厚度可以测量，包括大的、高折光、椭圆形或星形噬色素细胞，小的、中度折光的圆形淋巴细胞；真皮乳头层见纵行分布的扩张血管，血管周围炎症细胞、噬色素细胞浸润。RCM图像与组织病理结果具有较好的一致性。结论RCM实时、无创扫描技术可以作为儿童扁平苔藓诊断的辅助影像学检查手段。

Objective To assess the reflectance confocal microscopic features of childhood lichen planus （LP）, and to evaluate the performance of reflectance confocal microscopy （RCM） in the diagnosis of childhood LP. Methods RCM was performed for imaging of lesions in 35 children with LP. Then, biopsies were carried out at the same sites followed by histopathological examination. A comparison was conducted between confocal microscopic and histopathological findings. All the 35 cases were diagnosed based on clinical manifestations and histopathological findings. Results RCM imaging of lesions in the 35 cases showed cellular edema forming lowly reflective areas in the epidermis, sharp transition between the granular and spinous layers, and infiltration of moderately reflective inflammatory cells, which corresponded to wedge-shaped thickening of the granular layer on pathological examination. The dermo-epidermal junction was unclear, and dermal papillary rings were obscure or absent with infiltration of inflammatory ceils arranged in lamelliform structures around the dermo-epidermal junction, which corresponded to interface dermatitis on histopathological examination. A band-like infiltration of inflammatory cells, including big, highly reflective oval or stelliform pigmentophages and small, moderately reflective round lymphocytes, was observed in the dennis, and the thickness of infiltration was measurable. Dilated blood vessels were longitudinally distributed in the papillary dennis with perivascular infiltration of inflammatory cells and pigmentophages. RCM images were highly consistent with histopathological findings in these patients. Candusion RCM, as a real-time non-invasive imaging technique, can serve as an auxiliary examination method for the diagnosis of childhood LP.