内分泌、代谢、营养障碍性皮肤病

20091854 阴囊特发性皮肤钙沉着症伴发白癜风1例/佟长顺(北京平谷区医院皮肤科),杨立军∥中国皮肤性病学杂志.-2009,23(4).-239～240男,33岁。阴囊硬结21年,局部白斑6年。阴囊起结节前曾爬过树。查体见双阴囊簇集分布的8个黄豆大结节、斑块,质硬如骨,针挑后可挤出细小砂粒状乳酪样物质;结节下方见不规则乳白色斑片。X线片示结节皮损区有钙化斑点。结合病理确诊。图3参2(张江安)20091855成人单发黄色肉芽肿1例/张武(清华大学一附院皮肤科),王昕,常建民…∥中国皮肤性病学杂志.-2009,23(5),-307～308男,41岁。右前臂淡红色丘疹1年,约黄豆大小,质韧,无触     

皮肤钙质沉着症及治疗

目的:探讨皮肤钙质沉着症的临床特点及治疗方法.方法:回顾性分析2例皮肤钙质沉着症的临床资料.结果:1例头皮皮肤钙质沉着症为外伤性皮肤钙质沉着症,经皮肤扩张及皮瓣转移修复的手术方法治愈;另1 例为特发性阴囊皮肤钙质沉着症,因局部阴囊皮肤修复难度较大而放弃手术治疗.结论:皮肤钙质沉着症为临床少见病,组织病理活检可确诊,手术治疗是有效可靠的治疗方法,切除范围要足够以免复发,一期皮肤扩张器埋植,二期皮瓣转移修复对头皮病灶效果较满意.     

疣状增生表现的特发性皮肤钙沉着症

患儿女,13岁。左鼻部肿物2年余,渐增大。皮肤科检查:左鼻尖一表面少许颗粒样增生的疣状突起肿物,见毛细血管扩张,无压痛及破溃。系统体格检查及实验室检查未见异常。皮损组织病理检查见真皮内大量团块状钙盐沉积,毛细血管增生扩张,局部巨细胞浸润,并可见钙化物经表皮排出。诊断为特发性皮肤钙沉着症。     

白癜风患者皮肤组织液IL-2和sIL-2R水平的变化

将52例稳定期白癜风患者根据皮损分布分为寻常型与节段型,进行负压吸疱移植治疗,收集正常皮肤及白斑处的疱液,用酶联免疫吸附法检测皮肤组织液中IL-2和可溶性白介素-2受体(sIL-2R)水平变化.寻常型白癜风患者局部白斑处皮肤组织液IL-2水平较非白斑处降低,而sIL-2R水平较非白斑处增高;而节段型白癜风白斑与非白斑处皮肤组织液IL-2和sIL-2R水平无变化.寻常型稳定期白癜风患者局部白斑皮肤处于免疫异常状态,白癜风的发病可能与IL-2和sIL-2R的变化有关.     

白癜风患者皮肤组织液白介素-2及其可溶性受体水平变化的临床研究

目的:探讨细胞因子白介素-2(IL-2)及其可溶性受体(sIL-2R)在白癜风发病中的作用.方法:将52例稳定期白癜风患者根据皮损分布分为寻常型与节段型,进行负压吸疱移植治疗,收集正常皮肤及白斑处的疱液,用酶联免疫吸附法检测皮肤组织液中IL-2和sIL-2R水平变化.结果:寻常型白癜风患者局部白斑处皮肤组织液IL-2水平较非白斑处降低,而sIL-2R水平较非白斑处增高,差异有统计学意义,节段型白癜风白斑与非白斑处皮肤组织液IL-2和sIL-2R水平比较,无明显变化.结论:寻常型稳定期白癜风患者局部白斑皮肤处于免疫异常状态,白癜风的发病可能与IL-2和sIL-2R的变化有关.     

白癜风患者调节性T细胞及单核细胞趋化蛋白-1及可溶性细胞问黏附分子-1的检测

目的 探讨稳定期白癜风患者白斑与非白斑处皮肤单核细胞趋化蛋白-1（MCP-1）及可溶性细胞间黏附分子-1（sICAM-1）的变化以及血液中调节性T细胞的表达变化。方法 稳定期白癜风患者进行负压吸疱移植治疗，收集白斑及正常皮肤的疱液，用ELISA法检测皮肤组织液中MCP-1及sICAM-1的水平；收集稳定期白癜风患者血液与正常人比较，流式细胞仪观察调节性T细胞的变化。结果 稳定期白癜风患者，血液中调节性T细胞的表达与正常人差异无统计学意义：寻常型白癜风患者局部白斑与非白斑处皮肤吸引疱疱液MCP-1及sICAM-1水平比较均显著增高，经统计学分析，差异有统计学意义。节段型白癜风白斑与非白斑处MCP-1及sICAM-1的水平差异无统计学意义。结论 寻常型稳定期白癜风患者局部白斑皮肤微环境仍处于免疫异常状态，移植治疗的失败可能与局部微环境异常有关。     

白癜风患者调节性T细胞及单核细胞趋化蛋白-1及可溶性细胞间黏附分子-1的检测

目的 探讨稳定期白癜风患者白斑与非白斑处皮肤单核细胞趋化蛋白-1(MCP-1)及可溶性细胞间黏附分子-1(sICAM-1)的变化以及血液中调节性T细胞的表达变化.方法 稳定期白癜风患者进行负压吸疱移植治疗,收集白斑及正常皮肤的疱液,用ELISA法检测皮肤组织液中MCP-1及sICAM-1的水平;收集稳定期白癜风患者血液与正常人比较,流式细胞仪观察调节性T细胞的变化.结果 稳定期白癜风患者,血液中调节性T细胞的表达与正常人差异无统计学意义;寻常型白癜风患者局部白斑与非白斑处皮肤吸引疱疱液MCP-1及sICAM-1水平比较均显著增高,经统计学分析,差异有统计学意义.节段型白癜风白斑与非白斑处MCP-1及sICAM-1的水平差异无统计学意义.结论 寻常型稳定期白癜风患者局部白斑皮肤微环境仍处于免疫异常状态,移植治疗的失败可能与局部微环境异常有关.     

特发性阴囊钙沉着症1例

患者男,34岁。阴囊出现淡黄色丘疹、结节5年,无不适。阴囊处丘疹组织病理示:表皮棘层肥厚,真皮内见一大片状嗜碱性无定形、团块状物质位于囊肿内,囊肿周围少许淋巴细胞及组织细胞浸润,囊内容物未见网篮状或板层状的角质物,真皮内未见异物巨细胞及基底样细胞团块。诊断:特发性阴囊钙沉着症。     

线状盘状红斑狼疮伴皮肤钙沉着症1例

报告1例线状盘状红斑狼疮伴皮肤钙沉着症。患者女,36岁。因左侧头皮,额部,颧部和颊部带状萎缩性红斑20余年,局部起白色小结节2年就诊。皮肤科检查见左侧头皮额部,颧部和颊部有一纵行的带状萎缩性红斑,表面和毛细血管扩张和粘着性鳞屑,在额部萎缩性红斑上可见一半粒绿豆大的白色小结节,质硬,实验室检查示血钙和血磷均正常。分别取萎缩性红斑和白色小结节行组织病理检查,符合盘状红斑狼疮和皮肤钙沉着症组织病理学改变。     

体外冲击波碎石术治疗皮肤钙沉着症

皮肤钙沉着症（calcinosisdeposition）系指不溶性钙盐沉积在皮肤组织。临床主要表现为坚硬的丘疹、结节或肿块,破溃后排出奶酪色油状砂粒样物质。沉积的钙盐主要是无定形的磷酸钙、少量碳酸钙和极少的羟磷灰石。当沉积物为矿物质并形成骨样组织时称皮肤骨瘤或皮肤骨化。根据病因的小同,皮肤钙沉着症分特发性皮肤钙沉着症、转移性皮肤钙沉着症、营养不良性钙沉着症、医源性与创伤性皮肤钙沉着症4种类型。     

白癜风相关黑素细胞膜抗原VIT150、VIT90、VIT75纯化及分析

目的：纯化和分析白癜风相关的黑素细胞膜抗原，为蛋白质微量测序及筛选、克隆黑素细胞膜抗原打下基础。方法：培养高纯度的正常人黑素细胞，活细胞ELISA法和蛋白免疫印迹法(Western blot)检测并筛选抗黑素细胞的高滴度IgG抗体血清，生物素标记可溶性黑素细胞膜抗原，加入筛选血清与蛋白A-琼脂糖凝胶(protein A-sepharose)进行免疫共沉淀．沉淀后的抗原抗体复合物行平极电泳及电转印，碱性磷酸酶标记的亲合素进行化学发光法检测及鉴定。结果：活细胞ELISA法和Western blot检测结果中共筛选了10例白癜风患者高滴度IgG血清，免疫沉淀、免疫印迹、化学发光法检测后发现10例患者均有阳性条带，其抗原相对分子质量为150000、90000、75000、60000。结论：白癜风患者血清中存在抗黑素细胞膜抗原的自身抗体，抗原相对分子质量主要为150000、90000、75000，通过免疫共沉淀初步纯化了150000、90000和75000抗原。     

Role of apoptosis and melanocytorrhagy: a comparative study of melanocyte adhesion in stable and unstable vitiligo

Background Apoptosis and melanocytorrhagy have been proposed as mechanisms of melanocyte disappearance although there are few controlled studies. Objectives We undertook this project to study melanocyte morphology and adhesion defects in patients with stable and unstable disease in controls. Methods In this comparative study we included seven patients with stable disease and seven patients with unstable vitiligo. We cultured perilesional skin melanocytes from these patients with stable and unstable vitiligo and studied for morphological changes, adhesion to collagen type IV and caspase 3 expression. Melanocytes were also treated with okadaic acid and annexin V expression was then checked and compared between controls and patients with stable and unstable vitiligo. Results Perilesional skin melanocytes from patients with unstable vitiligo revealed some significant morphological changes. Melanocytes from unstable vitiligo showed significantly low adhesion to collagen type IV compared with control and stable vitiligo melanocytes. Our results showed that caspase 3 and annexin V staining was significantly greater in melanocytes cultured from unstable vitiligo compared with the control. Conclusions In this study we demonstrated that melanocytes in the patients with unstable vitiligo were in their detachment phase, which ultimately leads to apoptosis of these cells, whereas melanocytes cultured from controls and from patients with stable vitiligo were morphologically normal without any adhesion defects. These morphological and adhesion findings support the theory of melanocytorrhagy as the primary defect underlying melanocyte loss in unstable vitiligo.     

同种异体淋巴细胞与黑素细胞混合培养的实验研究

目的：黑素细胞与同种异体淋巴细胞混合培养,从体外实验来研究排斥反应的可能性。方法：采用^3H－dTR掺入同位素液态闪烁计数法测定淋巴细胞的转化增殖率,并用透射电镜观察混合培养后黑素细胞的超微结构。结果：黑素细胞对同种异体淋巴细胞的转化增殖率与ConA刺激淋巴细胞转化增殖的阳性对照比较,结果显示黑素细胞的促淋巴细胞转化增殖的特异性抗原作用较弱。进一步比较黑素细胞对不同病期白癜风患者淋巴细胞的影响,发现黑素细胞对活动期白癜风患者淋巴细胞的刺激作用相对较强,而稳定期患者和正常人对照组结果差异无显著性。同时电镜观察结果显示同种异体的淋巴细胞对黑素细胞无明显损伤,黑素细胞经混合培养后,细胞的形态完整,黑素合成功能正常,胞体和树突正损伤。细胞内细胞器丰富,胞浆内可见大量的不同阶段黑素小体。结论：正常人黑素细胞的促淋巴细胞转化增殖的异性抗原作用较弱。同种异体淋巴细胞对黑素细胞超微结构无破坏作用。在进行同种异体移植时最好选择稳定期患者。     

387例节段型白癜风患者的临床分析

目的 探讨节段型白癜风的病情发展特征。方法 问卷调查方法收集2011年10月至2012年10月于我科门诊就诊的387例节段型白癜风患者的资料,进行分析。结果 387例中329例（85.0%）发病由局限型发展为节段型,58例首发为节段型。在局限型发展为节段型患者中, 220/329例（66.9%）在发病前3个月进展最快,进展3年趋于稳定。在58/387例（15.0%）直接以节段型发病的患者中,40/58例（69.0%）在1个月内进展最快,1年后基本稳定。107/387例（27.6%）发病数年后病情仍不稳定。333/387例（86.0%）以单一神经节段发病,其中三叉神经分布区发病的患者173/333例（52.0%）。稳定长达1年的患者中,62例接受自体黑素细胞移植治疗,56例（90.3%）达到80%以上的复色效果。结论 节段型发病快于局限型发病,半数以上患者病情进展3年后稳定。自体黑素细胞移植治疗是稳定期节段型白癜风有效的治疗方法之一。     

黑素细胞对同种异体淋巴细胞转化增殖的影响

目的 观察体外培养人黑素细胞与同种异体的淋巴细胞混合后,黑素细胞对淋纠细胞的促转化、增殖作用。方法 用^3H－TdR掺入同位素兴态闪烁计数测定淋巴细胞的转化增殖率。实验结果应用t检验进行统计学分析。结果 黑素细胞对同种异体淋巴细胞的转化增殖率与刀豆蛋白（conA）刺激淋巴细胞转化、增殖的阳性对照比较,结果显示黑素细胞的促淋巴细胞转化、增殖的特异性抗原作用较弱。进一步比较黑素细胞对不同病期的白癜风患者的淋巴细胞的影响,发现黑素细胞对活动期白癜风患者淋巴细胞的刺激作用相对较强,而稳定期患者和正常人对正常组结果无显著性差异。结论 正常人黑素细胞的特异性抗原作用较弱,为同种异体黑素细胞移植治疗白癜风创造了有利的条件。     

Autologous melanocyte–keratinocyte suspension in the treatment of vitiligo

Background In stable vitiligo, several techniques of autologous transplantation of melanocytes are used. Autologous melanocyte transplantation of non‐cultured melanocytes is one of those techniques with variable reported outcomes. Objective The objective of this study was to evaluate the response to autologous melanocyte–keratinocytes suspension transplantation in cases of stable vitiligo. Methods A total of 25 cases of vitiligo were treated by autologous melanocyte–keratinocytes suspension transplantation. After 6–17 months, patients’ response was evaluated according to the extent of pigmentation (excellent 90–100%, good 50–89%, fair 20–49% and poor response <20%). Results Of the 25 patients treated, 22 continued the follow‐up period. Five (23%) patients showed excellent response, 7 (32%) good, 6 (27%) fair and 4(18%) showed poor response. Conclusion Unlike transplantation of cultured melanocytes, which requires experience in culture technique, autologous melanocyte–keratinocytes suspension transplantation is an easy economic technique, which may be used in resistant areas of stable vitiligo.     

白癜风患者血清中抗黑素细胞IgG抗体的检测及意义

目的：检测白癜风患者血清中抗黑素细胞IgG抗体并分析其与疾病活动性及发病类型的关系。方法：通过体外黑素细胞培养，采用问接免疫荧光技术测定白癜风患者血清中抗黑素细胞IgG抗体。结果：进展期白癜风患者抗黑素细胞抗体水平明显高于稳定期及正常人，进展期寻常型白癜风中泛发性患者抗体滴度明显高于局限性者，差异均有统计学意义。结论白癜风患者血清中抗黑素细胞IgG抗体与疾病的活动性及发病类型有一定的关系，支持白癜风与自身免疫有关。     

Histamine effect on melanocyte proliferation and vitiliginous keratinocyte survival

Repigmention of vitiligo requires melanocyte proliferation and migration. Keratinocytes have been shown to play a role in this process. Data from this laboratory showed that bee venom (BV) stimulated melanocyte proliferation and migration as well as melanogenesis. As histamine release is associated with BV, its effect on melanocyte proliferation and migration was examined. Cultured normal human melanocytes treated with histamine were studied with and without receptor-specific antagonists or agonists. The effect of histamine on vitiliginous keratinocytes, in cultured cells treated with a PI3K inhibitor in the presence of TNF-α, was also examined. Histamine exerted a more significant effect on melanocyte proliferation than on melanogenesis. This occurred through the H2 receptor with complex signalling to ERK, CREB, and Akt activation, which stimulated melanocyte migration. Histamine and the H2 receptor agonist also increased survival of vitiliginous, but not normal, keratinocytes, with NF-κB activation. Because expression levels of the H2 receptor was significantly decreased in depigmented compared to normally pigmented epidermis, in patients with vitiligo, histamine may increase the survival of vitiliginous keratinocytes. Overall, histamine stimulated the proliferation and migration of melanocytes and the vitiliginous keratinocyte survival, providing the basis for novel therapeutic approaches to vitiligo repigmentation.     

白癜风患者血清中抗黑素细胞IgG,IgM抗体的检测及补体介导的血清细胞毒反应

为探讨白癜风血清中的抗黑素细胞抗体类型和反应模式以及对黑素细胞的损伤作用 ,以免疫组化法检测了白癜风患者血清中抗黑素细胞IgG、IgM抗体 ,并以吖啶橙 /溴化乙锭细胞染色法观察补体介导的白癜风血清对黑素细胞损伤作用。结果发现 2 5例活动性寻常型白癜风患者血清中有 19例检出IgG型抗体 ,2 1例检出IgM型抗体 ,明显高于稳定期和正常对照组血清 ;2 5例活动期血清 9例出现对黑素细胞的明显细胞毒作用 ,高于正常人血清 ,对照的成纤维细胞未出现明显的细胞毒作用。结果提示白癜风患者血清内有抗黑素细胞IgG、IgM抗体 ,这些抗体可以通过补体选择性的损伤体外培养的黑素细胞 ,支持白癜风是一种自身免疫性疾病的假设。     

Non‐cultured melanocyte‐keratinocyte transplantation for the treatment of vitiligo: a clinical trial in an Iranian population

Background Non‐cultured cellular grafting as a surgical procedure is indicated to treat stable vitiligo, refractory to medical treatment, and is gaining wider acceptance among dermatologists. Objective The aim of this study was to assess the efficacy of non‐cultured melanocyte‐keratinocyte transplantation (MKT) for the treatment of generalized vitiligo in Iranian patients. Methods In this clinical trial, a total of 14 vitiligo patches in eight patients were treated; eight patches with non‐cultured MKT and six patches dermabraded alone without application of keratinocyte‐melanocyte suspension. Repigmentation was compared at about 4 months post‐transplantation. Results Of the eight lesions treated with non‐cultured MKT, four lesions showed 96–100% repigmentation, one lesion 65–95% and three lesions 0–25%. Of the patients who showed excellent results, only one showed a post‐inflammatory hyperpigmentation in recipient and control areas. Of the six control lesions, five showed failed repigmentation and one showed post‐inflammatory hyperpigmentation. Conclusion Non‐cultured MKT is an effective method to treat stable vitiligo. Studies on larger series of vitiligo patients are required to confirm its efficacy.