皮肤镜动态观察银屑病治疗前后血管变化与皮损变化的相关性
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摘要
目的皮肤镜动态观察寻常性银屑病有效治疗后皮损血管的改变及其与皮损临床改变的相关性。方法选取24例临床持续治疗的寻常性银屑病患者于治疗0、1、2、3、4、6周使用皮肤镜进行皮损处血管变化的动态连续性观察,并同时对同一皮损进行临床评分并记录,比较皮损临床变化与血管球变化的关系。结果①银屑病皮损在0～4周有效治疗后皮损TLS评分下降,皮损处血管球直径缩小,血管往正常回归,4～6周皮损加重,TLS评分增加,皮损处血管球直径变大,血管扩张加重。②银屑病皮损TLS评分与血管球直径随时间变化的变化趋势一致,均为0～4周降低,4～6周增加。前者下降速度快于后者。③银屑病皮损TLS下降率(I1)与血管球直径下降率(I2)随时间变化的变化趋势呈正相关性,具有统计学意义(r=0.973,P<0.01)。结论银屑病皮损变化与血管变化呈正相关,提示皮肤镜下皮损血管变化可作为微观观察指标用于银屑病皮损恢复情况及临床药物疗效的观察。
Objective To dynamically observe the changes of vessels in skin lesions under the dermatoscope after effective treatment of psoriasis vulgaris and its correlation with the clinical changes of skin lesions. Methods Twenty four psoriasis vulgaris patients treated continuously were selected to observe the dynamic continuity of vascular changes with the dermatoscope at the lesions for 0,1,2,3,4 and 6 weeks. And we evaluated and recorded the same lesions and compared the relationship between the clinical changes of lesions and the changes in blood vessel bulbs. Results ①After 0 to 4 weeks effective treatment of psoriatic lesions,TLS score decreased,the diameter of the vascular sphere at the lesion reduced,the blood vessels returned to normal. After 4 to 6 weeks,the lesions aggravated,the TLS score increased,and the vascular diameter at the lesions became larger and the vasodilation aggravated.②The change of TLS score of psoriatic lesions was consistent with the change in vascular diameter over time,both decreasing from 0 to 4 weeks and increasing from 4 to 6 weeks. The former declines faster than the latter.③The TLS decreasing rate of psoriatic lesions(I1) was positively correlated with the decreasing rate of vascular diameter(I2) with time(r=0.973,P<0.01),statistically significant.Conclusion The change of psoriasis lesions is positively correlated with vascular changes,which suggests that vascular changes of skin lesions under the dermatoscope can be used as microscopic observation indicator to observe the recovery of psoriasis lesions and efficiency of the clinical drug.
Objective To dynamically observe the changes of vessels in skin lesions under the dermatoscope after effective treatment of psoriasis vulgaris and its correlation with the clinical changes of skin lesions. Methods Twenty four psoriasis vulgaris patients treated continuously were selected to observe the dynamic continuity of vascular changes with the dermatoscope at the lesions for 0,1,2,3,4 and 6 weeks. And we evaluated and recorded the same lesions and compared the relationship between the clinical changes of lesions and the changes in blood vessel bulbs. Results ①After 0 to 4 weeks effective treatment of psoriatic lesions,TLS score decreased,the diameter of the vascular sphere at the lesion reduced,the blood vessels returned to normal. After 4 to 6 weeks,the lesions aggravated,the TLS score increased,and the vascular diameter at the lesions became larger and the vasodilation aggravated.②The change of TLS score of psoriatic lesions was consistent with the change in vascular diameter over time,both decreasing from 0 to 4 weeks and increasing from 4 to 6 weeks. The former declines faster than the latter.③The TLS decreasing rate of psoriatic lesions(I1) was positively correlated with the decreasing rate of vascular diameter(I2) with time(r=0.973,P<0.01),statistically significant.Conclusion The change of psoriasis lesions is positively correlated with vascular changes,which suggests that vascular changes of skin lesions under the dermatoscope can be used as microscopic observation indicator to observe the recovery of psoriasis lesions and efficiency of the clinical drug.
引文
[1]Stinco G,Lautieri S,Valent F,et al.Cutaneous vascular alterations in psoriatic patients treated with cyclosporine[J].Acta Derm Venereol,2007,87(2):152-154.
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[6]Stinco G,Lautieri S,Patrone P.Videocapillaroscopic study in psoriatic patients treated with tacalcitol[J].G Ital Dematol Venereol,2006,141:227-231.
[7]Telner P,Fekete Z.The capillary responses in psoriatic skin[J].Invest Dermatol,1961,36:225-230.
[8]Pinkus H,Mehregan AH.The primary histologic lesion of se borrheic dermatitis and psori asis[J].Invest Dermatol,1966,46(1):109-116.
[9]Creamer D,Jaggar R,Allen M,et al.Overexpression of the angiogenic factor platelet-derived endotelial cell growth factor/thymidine phosphorilase in psoriatic epidermis[J].Br JDermatol,1997,137(6):851-855.
[10]Braverman IM,Sibley J.Role of the microcirculation in the treatment and pathogenesis of psoriasis[J].J Invest Dermatol,1982,78(1):12-17.
[11]Hern S,Mortimer PS.In vivo quantification of microvessels in clinically uninvolved psoriatic skin and in normal skin[J].Dermatol,2007,156(6):1224-1229.
[2]Rosina P,Giovannini A,Gisondi P,et al.Microcirculatory modifications ofpsoriatic lesions during topical therapy[J].Skin Res Technol,2009,15(2):135-138.
[3]Detmar M,Brown LF,Claffey KP,et al.Overexpression of vascular permeability factor/vascular endothelial growth factor and its receptors in psoriasis[J].J Exp Med,1994,180(3):1141-1146.
[4]Debets R,Hegmans JP,Troost RJ,et al.Enhanced production of biologically active interleukin-1αand interleukin-1βby psoriatic epidermal cells ex vivo:evidence of increased cytosolic interleukin-1βlevels and facilitated interleukin-1release[J].Eur J Immunol,1995,25(6):1624-1630.
[5]Sturmia R,Altieri E,Romani I,et al.Tacalcitol in psoriasis:a video-microscopy study[J].Acta Derm Venereol Suppl,1994,186:85-87.
[6]Stinco G,Lautieri S,Patrone P.Videocapillaroscopic study in psoriatic patients treated with tacalcitol[J].G Ital Dematol Venereol,2006,141:227-231.
[7]Telner P,Fekete Z.The capillary responses in psoriatic skin[J].Invest Dermatol,1961,36:225-230.
[8]Pinkus H,Mehregan AH.The primary histologic lesion of se borrheic dermatitis and psori asis[J].Invest Dermatol,1966,46(1):109-116.
[9]Creamer D,Jaggar R,Allen M,et al.Overexpression of the angiogenic factor platelet-derived endotelial cell growth factor/thymidine phosphorilase in psoriatic epidermis[J].Br JDermatol,1997,137(6):851-855.
[10]Braverman IM,Sibley J.Role of the microcirculation in the treatment and pathogenesis of psoriasis[J].J Invest Dermatol,1982,78(1):12-17.
[11]Hern S,Mortimer PS.In vivo quantification of microvessels in clinically uninvolved psoriatic skin and in normal skin[J].Dermatol,2007,156(6):1224-1229.