慢性光化性皮炎173例临床与病理分析

A Clinicopathological Analysis of 173 Cases with Chronic Actinic Dermatitis

目的探讨慢性光化性皮炎(CAD)的临床及病理特征。方法回顾性分析173例慢性光化皮炎性患者的临床和病理资料。结果 173例CAD患者中男158例,女15例,平均年龄(58. 26±12. 86)岁,其中60~79岁患者114例; 59例CAD患者行光敏试验检查,UVB敏感46例,对UVA、UVB均敏感11例,对UVA无反应42例。其中126例CAD患者行组织病理检查,表皮角化过度45例,角化过度伴角化不全73例,有渗出、结痂12例,棘层水肿77例,基底层完整50例,基底层液化变性21例,真皮胶原嗜碱变性33例,伴嗜酸性粒细胞浸润26例,炎细胞外渗23例,合并蕈样肉芽肿3例,典型Pautrier微脓肿2例。免疫组织化学显示对Ki-67、CK、CRO-45均阳性。结论该病皮损主要位于曝光部位;组织病理似慢性湿疹、皮炎样改变,特征性表现为真皮胶原嗜碱变,伴嗜酸性粒细胞浸润,未见有光敏性皮炎(PD相)向光线性类网织细胞增生症(AR相)转化病例。

Objective To investigate the clinical and pathological features of patients with chronic actinic dermatitis（CAD）. Methods The clinical and histopathological results of173 patients with CAD were collected and analyzed. Results The male patients were158 cases（91. 33%）,and the females were 15 cases（8. 67%）. The average age was 58. 26 ± 12. 86,and the amount of age between 60 and 79（65. 90%） was 114 cases. There were 59 patients who conducted photosensitive text,and the results showed that 46 cases were sensitive to UVB（77. 97%）,and 11 cases to both UVA and UVB（18. 64%）,42 cases showed non-response to UVA（71. 19%）. Histopathological examination showed： epidermal hyperkeratosis（45 cases）,hyperkeratosis accompanied parakeratosis（73 cases）,exudation and crust（12 cases）,stratum spinosum edema（77 cases）. Conclusion The lesions locate mainly in the exposed position. The histopathology examination is similar to chronic eczema and derma-titis,characterized as dermal collagen basophilic and eosinophil infiltration. There is no case transferred from photosensitivity dermatitis（PD） to actinic reticuloid（AR）.