反射式共聚焦显微镜在头皮银屑病早期诊断中的应用

Role of in vivo reflectance confocal microscopy in the diagnosis of scalp psoriasis

目的:探讨头皮银屑病的反射式共聚焦显微镜(RCM,简称皮肤CT)图像特征,分析皮肤CT在其诊治中的临床意义。方法:选取临床拟诊为头皮银屑病患者55例,分别行皮肤CT扫描检查和组织病理检查,分析皮肤CT对头皮银屑病的特征表现及诊断准确度。结果:头皮银屑病皮肤CT的主要特征为角化不全,Munro微脓肿,真皮乳头上顶、真皮乳头密度增加、规则排列,真皮乳头内明显迂曲扩张充血的血管。皮肤CT诊断银屑病47例(85.5%),通过病理检查确诊银屑病49例(89.1%),以病理检查为金标准,皮肤CT检查诊断的灵敏度为91.8%(45/49),特异度为66.7%(4/6),准确度89.1%(49/55),误诊率33.3%(2/6),漏诊率8.2%(4/49),Youden指数为0.585,Kappa值为0.510(P<0.05)。结论:RCM(皮肤CT)扫描检查对头皮银屑病具有辅助诊断及提供鉴别诊断线索的作用,值得临床推广。

Objective:To investigate the imaging features of reflectance confocal microscopy(RCM)in patients with scalp psoriasis,and to analyze the clinical significance of RCM in the diagnosis of scalp psoriasis.Methods:Total 55 patients with scalp psoriasis were enrolled,with RCM scan and histopathological examination were performed respectively.Results:For scalp psoriasis,the significant features were parakeratosis,Munro-micro-abscess,multiple and enlarged dermal papillae,which arrange regularly,and the blood vessels in dermal papillae were dilated and congested.Compared with the histopathology diagnosis,the sensitivity rate,the specific rate,the accuracy rate,the misdiagnosis rate,the missed diagnosis rate,the Youden index and the Kappa value of RCM in diagnosis of scaple psoriasis were respectively 91.8%,66.7%,89.1%,33.3%,8.2%,0.585 and 0.510(P<0.05).Conclusion:RCM scan not only plays an auxiliary role in the diagnosis of scalp psoriasis but also provides clues for differential diagnosis.