高频超声检查在带状疱疹患者皮肤及周围神经病变中的应用研究
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摘要
目的：研究高频超声显示皮肤及皮神经的可行性；高频超声测量皮肤各层结构及皮神经的准确性；观察带状疱疹患者局部皮肤及皮神经病理解剖变化所致的高频超声声像图改变，为进一步研究带状疱疹患者未出疹前或无疹型及后遗神经痛的声像图改变提供实验依据，进而为临床早期诊断，减少误诊寻求影像学依据。方法：分为动物实验及临床实验两部分。动物实验部分对刚处死的5只猪两侧胸肋部连皮带骨肉共10块进行高频超声检查，分别在解剖前及解剖后用针标定皮肤各层结构后进行检测，并与大体标本及组织学检查对照，以验证该方法的可行性并确定正常皮肤、皮下组织及皮神经的超声声像图特征。临床实验部分检测带状疱疹患者37例，共77处病变，后遗神经痛患者7例，共17处病变，均以同一患者健侧对应部位做对照，观察皮肤及皮下组织厚度、回声特征及皮神经的宽度、回声特征。结果：高频超声所示皮肤各层结构及皮神经声像图与大体标本及组织学所见正确对应；皮肤厚度、皮下组织厚度及皮神经直径的超声及大体标本测值经统计学处理无差异性(P＞0.05)；带状疱疹患者皮肤、皮下组织均增厚(P＜0.01)，
回声减低;受累皮神经增粗(P<0.01)，回声减低，线性结构模糊。
后遗神经痛患者皮肤、皮下组织改变不明显(P>0.05)，受累皮神经
增粗(P<0.01)，回声增强，线性结构模糊。结论:高频超声可正
确认识皮肤、皮下组织及皮神经结构;高频超声测量皮肤各层结构
及皮神经方法简单、准确;高频超声可客观显示带状疮疹患者皮肤、
皮神经炎性病理改变异常声像图。
Objective : To study the feasibility of using high frequence ultrasound scan to show skin and skin nerves ; To study the accuracy of using high frequence ultrasound to measure each layer of skin and skin nerves ; To observe the changes of image features of high frequence ultrasound , which is caused by the pathology-anatomy changes in the local skin or peripheral nerves ; In order to provide the base for studying the image changes of herpes zoster ; Further more it provides image base for early diagnosis and reducing the percentage of misdiagnosing . Methods : The experiment was divided into two parts-animal experimental part and clinical one . In the animal experimental part ,10 slices of skin (together with meat) from the chest of five pigs which had been just killed were examined with high frequence ultrasound . Each layer of the skin had been signed with needles separately before and after their analysis . They were also contrasted with whole specimen and the histological examination in order to test the
feasibility of the method and to confirm the features of ultrasound images in normal skin , subcutaneous tissue and skin
nerves . In the clinical experiment, 37 cases of herpes zoster patients with 77 pathological changes were examined , 7 cases of sequence of neuralgia with 17 pathological changes . They were all compared with the healthy side of the same patient .We observed the thickness of the skin and subcutaneous tissue , the echoing feature and the width of the skin nerves . Results : The image of the structure of skin and skin nerves showed by high frequence ultrasound corresponded with whole specimen and its histological examination exactly . The image that showed the thickness of skin and subcutaneous tissue , the diameters of skin nerves as well as the measurement of the whole specimen had no statistic discrepancy ( P>0.05) . On one hand , the skin and subcutaneous tissue of the herpes zoster patients became thicker (P<0.01),but the ones of the patients who have sequel to neuralgia changed little (P>0.05) . Both of their nerves were widen (P<0.01) . The line structure were all vague . On the other hand , the echo of the nerves is former one was lower , but the latter one's was stronger . Conclusion : The high frequence ultrasound scan can identify the structure of skin ,subcutaneous tissue and skin nerves exactly .The usage is simple and accurate . At the same time , the high
frequence ultrasound scan can show the inflammatory pathological image of the skin , skin nerves of herpes zoster patients objectively .
回声减低;受累皮神经增粗(P<0.01)，回声减低，线性结构模糊。
后遗神经痛患者皮肤、皮下组织改变不明显(P>0.05)，受累皮神经
增粗(P<0.01)，回声增强，线性结构模糊。结论:高频超声可正
确认识皮肤、皮下组织及皮神经结构;高频超声测量皮肤各层结构
及皮神经方法简单、准确;高频超声可客观显示带状疮疹患者皮肤、
皮神经炎性病理改变异常声像图。
Objective : To study the feasibility of using high frequence ultrasound scan to show skin and skin nerves ; To study the accuracy of using high frequence ultrasound to measure each layer of skin and skin nerves ; To observe the changes of image features of high frequence ultrasound , which is caused by the pathology-anatomy changes in the local skin or peripheral nerves ; In order to provide the base for studying the image changes of herpes zoster ; Further more it provides image base for early diagnosis and reducing the percentage of misdiagnosing . Methods : The experiment was divided into two parts-animal experimental part and clinical one . In the animal experimental part ,10 slices of skin (together with meat) from the chest of five pigs which had been just killed were examined with high frequence ultrasound . Each layer of the skin had been signed with needles separately before and after their analysis . They were also contrasted with whole specimen and the histological examination in order to test the
feasibility of the method and to confirm the features of ultrasound images in normal skin , subcutaneous tissue and skin
nerves . In the clinical experiment, 37 cases of herpes zoster patients with 77 pathological changes were examined , 7 cases of sequence of neuralgia with 17 pathological changes . They were all compared with the healthy side of the same patient .We observed the thickness of the skin and subcutaneous tissue , the echoing feature and the width of the skin nerves . Results : The image of the structure of skin and skin nerves showed by high frequence ultrasound corresponded with whole specimen and its histological examination exactly . The image that showed the thickness of skin and subcutaneous tissue , the diameters of skin nerves as well as the measurement of the whole specimen had no statistic discrepancy ( P>0.05) . On one hand , the skin and subcutaneous tissue of the herpes zoster patients became thicker (P<0.01),but the ones of the patients who have sequel to neuralgia changed little (P>0.05) . Both of their nerves were widen (P<0.01) . The line structure were all vague . On the other hand , the echo of the nerves is former one was lower , but the latter one's was stronger . Conclusion : The high frequence ultrasound scan can identify the structure of skin ,subcutaneous tissue and skin nerves exactly .The usage is simple and accurate . At the same time , the high
frequence ultrasound scan can show the inflammatory pathological image of the skin , skin nerves of herpes zoster patients objectively .
引文
1. Heskel Ns, Hanifin JM. "Recurent herpes zoster": an unproved entity? J Am Acad dermatal, 1994,10(3): 486-490
2. Morgan R, King D. characteristics of patients with shingles admitted to a district general hospital. Postgrad Med J, 1998, 74(868): 101-103
3．彭小东，项红兵．急性带状疱疹误诊32例分析．中国现代医学杂志，2001，011：81-82
4．张起律．带状疱疹早期神经痛误诊30例分析．中国误诊学杂志，2001，1(1)：116-117
5．索峻，杜华．带状疱疹误诊慢性胆囊炎1例．临床皮肤科杂志，2002，31(7)：449
6．邹泉，张地君．临床各科误将带状疱疹诊断为其他疾病83例临床分析．皮肤病与性病杂志，2000，22(1)：31-32
7. Milner SM, Memar OM, Gherardini G. The histological interpretation of high frequency cutaneous ultrasound imaging. Dermatology surgery, 1997, 23(1): 43-45
8. Serup J. Ten years' experience with high-frequency ultrasound examination of the skin. Development and refinement of technique and equipment.In: Ultrasound in Dermatology(Altmeyer P, el-Gammal S, Hoffmann K, eds). Berlin: Springer-Verlag, 1992, 41-45
9. Altmeyer P, Hoffmann K; Stucker M, et al. General phenomena of ultrasound in dermatology. In: Ultrasound in Dermatology(Altmeyer P, el-Gammal S, Hoffmann K, eds). Berlin: Springer-Verlag, 1992: 55-79
10. Fornage BD, Mcgavyan MH, Duvic M, et al. Imaging of skin with 20-MHz US. Radiology, 1993,189(1): 69-76
11. El-Gammals. Experimental approaches and new developments in high frequency ultrasound in dermatology. Zentrabl Haut Qeschlechtskr, 157: 327-332
12. El-Gammals, Hoffmann A, Hoss R, et al, New concept and developments in high-resolution ultrasound. In: Ultrasound in Dermatology(Altmeyer P, el-Gammal S, Hoffmann K, eds).Berlin: Springer-Verlag, 1992: 399-419
13. Fomage BD. Skin and subcutaneous tissues. Clinics in diagnostic ultrasound, 1995, 30: 85-98
14. Marks R, Motley RJ. Skin cancer. Recognition and treatment.Drugs, 1995, 50(1): 48-61
15. Seidenaris S, Belletti B, ContiA. A quantitative description of echographic images of sclerotic skin in patients with systemic sclerosis, as assessed by computerized image analysis on 20-MHz
B-scan recordings. Acta dermato-venereologica, 1996, 76(5): 361-365
16. Brock K, Stender I, Kartsmark T, et al. Ultrasonic measurement of skin thinkness in patients with systemic sclerosis. Acta derrnato-venereologica, 2000, 80(1): 59-62
17．方平，谭跃萍，金修才．高分辨率超声对皮肤探查的可行性研究．中国超声医学杂志，2001，17(2)：101-102
18．候家声，刘实．高频超声切面显像诊断皮肤疾病．中国医学影像技术，1999，15(5)：389-390
19．张缙熙，姜玉新主编．浅表器官及组织超声诊断学．第1版．北京：科学技术文献出版社，2002，171-181
20．M．A．蒙塔纳，M．L．理查森主编．肌肉骨骼系统超声诊断．第1版．上海：上海科技普及出版社，1992，70-116
21．孟华，张缙熙．高频超声诊断外周神经系统疾病．中华超声影像学杂志，1998，7(3)：187-188
22．郭瑞军，王明花，于亚东等．高频超声在外周神经、肌腱、肌肉的应用冲国超声医学杂志，1998，14(12)：32-35
23．于亚东，洪光祥，王发斌等．周围神经损伤的B超诊断．中华手外科杂志，1998，14(2)：111-113
24．郭瑞军，王克成，王明花等．肢体恶性肿瘤术前高频彩超检查的
意义．中国医学影像学杂志，2002，8：48-50
25. Fornage BD. Sonography of peripheral nerves of the extremities.Radiology medicine, 1993, 85(5 Suppl 1): 162-167
26. Graif M, Avi S, Nerubai J, et al. Sciatic nerve: sonographic evaluation and anatomic pathologic considerations. Radiology, 1991,181: 405-408
27. Sener RN, Alper H, Q.zturk L, et al. Retroperitional part of the femoral nerve: normal ultrasound features. Neuroradiology,1991, 33: 159-161
28. Silvestri E, Martinoli C, "Derchi LE, et al. Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Rediology, 1995,197,: 291-296
29. Ramin B, Seng-Jaw S, Heidi L, et al. Phase specific analysis of herpes zoster associated pain data: a new statistical approach.Statistics in medicine, 2001, 20: 2429-2439
30．刘辅仁主编．实用皮肤科学．第2版．北京：人民卫生出版社，1997，137-138
31．杨国亮主编．皮肤病学．第1版．上海：上海医科大学出版社，1992，263-266
32．张开明，王刚，尹国华主编．最新皮肤科学理论与实践．第1版．北京：中国医药科技出版社，2001，117-118
33．董郡主编．病理学．第2版．北京：人民卫生出版社，1998，119-143
34．高天文，孙建方主编．现代皮肤组织病理学．第1版．北京：人民卫生出版社，2001，68
35．朱学俊，涂平主编．皮肤病的组织病理诊断．第2版．北京：北京医科大学出版社，2001，119
2. Morgan R, King D. characteristics of patients with shingles admitted to a district general hospital. Postgrad Med J, 1998, 74(868): 101-103
3．彭小东，项红兵．急性带状疱疹误诊32例分析．中国现代医学杂志，2001，011：81-82
4．张起律．带状疱疹早期神经痛误诊30例分析．中国误诊学杂志，2001，1(1)：116-117
5．索峻，杜华．带状疱疹误诊慢性胆囊炎1例．临床皮肤科杂志，2002，31(7)：449
6．邹泉，张地君．临床各科误将带状疱疹诊断为其他疾病83例临床分析．皮肤病与性病杂志，2000，22(1)：31-32
7. Milner SM, Memar OM, Gherardini G. The histological interpretation of high frequency cutaneous ultrasound imaging. Dermatology surgery, 1997, 23(1): 43-45
8. Serup J. Ten years' experience with high-frequency ultrasound examination of the skin. Development and refinement of technique and equipment.In: Ultrasound in Dermatology(Altmeyer P, el-Gammal S, Hoffmann K, eds). Berlin: Springer-Verlag, 1992, 41-45
9. Altmeyer P, Hoffmann K; Stucker M, et al. General phenomena of ultrasound in dermatology. In: Ultrasound in Dermatology(Altmeyer P, el-Gammal S, Hoffmann K, eds). Berlin: Springer-Verlag, 1992: 55-79
10. Fornage BD, Mcgavyan MH, Duvic M, et al. Imaging of skin with 20-MHz US. Radiology, 1993,189(1): 69-76
11. El-Gammals. Experimental approaches and new developments in high frequency ultrasound in dermatology. Zentrabl Haut Qeschlechtskr, 157: 327-332
12. El-Gammals, Hoffmann A, Hoss R, et al, New concept and developments in high-resolution ultrasound. In: Ultrasound in Dermatology(Altmeyer P, el-Gammal S, Hoffmann K, eds).Berlin: Springer-Verlag, 1992: 399-419
13. Fomage BD. Skin and subcutaneous tissues. Clinics in diagnostic ultrasound, 1995, 30: 85-98
14. Marks R, Motley RJ. Skin cancer. Recognition and treatment.Drugs, 1995, 50(1): 48-61
15. Seidenaris S, Belletti B, ContiA. A quantitative description of echographic images of sclerotic skin in patients with systemic sclerosis, as assessed by computerized image analysis on 20-MHz
B-scan recordings. Acta dermato-venereologica, 1996, 76(5): 361-365
16. Brock K, Stender I, Kartsmark T, et al. Ultrasonic measurement of skin thinkness in patients with systemic sclerosis. Acta derrnato-venereologica, 2000, 80(1): 59-62
17．方平，谭跃萍，金修才．高分辨率超声对皮肤探查的可行性研究．中国超声医学杂志，2001，17(2)：101-102
18．候家声，刘实．高频超声切面显像诊断皮肤疾病．中国医学影像技术，1999，15(5)：389-390
19．张缙熙，姜玉新主编．浅表器官及组织超声诊断学．第1版．北京：科学技术文献出版社，2002，171-181
20．M．A．蒙塔纳，M．L．理查森主编．肌肉骨骼系统超声诊断．第1版．上海：上海科技普及出版社，1992，70-116
21．孟华，张缙熙．高频超声诊断外周神经系统疾病．中华超声影像学杂志，1998，7(3)：187-188
22．郭瑞军，王明花，于亚东等．高频超声在外周神经、肌腱、肌肉的应用冲国超声医学杂志，1998，14(12)：32-35
23．于亚东，洪光祥，王发斌等．周围神经损伤的B超诊断．中华手外科杂志，1998，14(2)：111-113
24．郭瑞军，王克成，王明花等．肢体恶性肿瘤术前高频彩超检查的
意义．中国医学影像学杂志，2002，8：48-50
25. Fornage BD. Sonography of peripheral nerves of the extremities.Radiology medicine, 1993, 85(5 Suppl 1): 162-167
26. Graif M, Avi S, Nerubai J, et al. Sciatic nerve: sonographic evaluation and anatomic pathologic considerations. Radiology, 1991,181: 405-408
27. Sener RN, Alper H, Q.zturk L, et al. Retroperitional part of the femoral nerve: normal ultrasound features. Neuroradiology,1991, 33: 159-161
28. Silvestri E, Martinoli C, "Derchi LE, et al. Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Rediology, 1995,197,: 291-296
29. Ramin B, Seng-Jaw S, Heidi L, et al. Phase specific analysis of herpes zoster associated pain data: a new statistical approach.Statistics in medicine, 2001, 20: 2429-2439
30．刘辅仁主编．实用皮肤科学．第2版．北京：人民卫生出版社，1997，137-138
31．杨国亮主编．皮肤病学．第1版．上海：上海医科大学出版社，1992，263-266
32．张开明，王刚，尹国华主编．最新皮肤科学理论与实践．第1版．北京：中国医药科技出版社，2001，117-118
33．董郡主编．病理学．第2版．北京：人民卫生出版社，1998，119-143
34．高天文，孙建方主编．现代皮肤组织病理学．第1版．北京：人民卫生出版社，2001，68
35．朱学俊，涂平主编．皮肤病的组织病理诊断．第2版．北京：北京医科大学出版社，2001，119