皮疹组织病理在成人Still病诊断中的临床意义

Clinical Significance of Rash Histopathology in the Diagnosis of Adult Still's Disease

目的探讨成人Still病(adult-onset Still's disease,AOSD)皮疹的病理形态特点和临床意义,为此病的早期诊断提供帮助。方法回顾性分析本科收治的21例AOSD患者的临床和组织学表现,包括持续性瘙痒性皮疹(persistent pruritic eruptions,PPEs)(n=14)和一过性皮疹(evanescent skin eruptions,ESEs)(n=7)。结果所有患者均符合AOSD疾病的诊断标准,21例患者均出现过不同程度的皮疹。患者皮疹病理取材于PPEs或ESEs,大部分PPEs和/或ESEs病理可见表皮上1/3层不同程度的角化不良细胞,无炎症浸润,伴有真皮浅层血管周围淋巴细胞、中性粒细胞浸润。其中,ESEs表皮浅层角化不良细胞较少,而PPEs表皮浅层角化不良细胞多,部分呈“串珠样”。结论成人Still病中皮疹有较高的发生率,皮疹的病理具有一定特征性,能为疾病的早期诊断提供帮助。

Objective To investigate the pathomorphological features and clinical significance of skin rash in adults onset Still's disease(AOSD)and to provide help for early diagnosis of this disease.Methods The clinical and histopathological features of 21 patients with AOSD treated in our department were analyzed retrospectively,including persistent pruritic eruptions(PPEs)(n=14)and evanescent skin eruptions(ESEs)(n=7).Results All the patients met the diagnostic criteria of AOSD disease and all of them had different skin rashes.Biopsies were carried out at the sites of PPEs or ESEs.Most of PPEs and(or)ESEs presented dyskeratotic keratinocytes in the upper 1/3 of the epidermal layer without inflammatory infifiltrates,accompanied by infiltration of lymphocytes and neutrophils around the superficial vessels of the dermis.For ESEs,there were few dyskeratotic keratinocytes in superficial epidermis,but for PPEs,there were more,and some of them were"bead-like".Conclusion There is a high incidence of rash in adult Still disease and the histopathology of rash has certain characteristics,which can provide clues for the early diagnosis of the disease.