偏振光皮肤镜下玫瑰花瓣征的诊断价值

目的 探讨偏振光皮肤镜下玫瑰花瓣征的诊断意义。方法 回顾北京大学第三医院皮肤科2014年9月至2017年3月偏振光皮肤镜资料库中图片，选出出现玫瑰花瓣征的皮损，进一步选出有组织病理支持的皮损，分析玫瑰花瓣征与疾病的相关性。将上述有组织病理诊断的皮损分为光线性角化病（AK）组及非AK组，比较两组间临床和皮肤镜特征的差异，并用非参数检验比较AK与非AK组间、不同部位间玫瑰花瓣征数量的差异。结果 回顾性分析4 956例皮损的皮肤镜图像，144例（2.91%）出现玫瑰花瓣征，其中74例经组织病理确诊，37例为AK（50.00%）；AK组与非AK组间在皮损部位（是否位于面部，χ2 = 23.786，P < 0.001；是否位于曝光部位，χ2 = 12.921，P < 0.001）以及皮肤镜下表面鳞屑（χ2 = 7.056，P = 0.008）、角栓（χ2 = 6.167，P = 0.013）、毛囊口周围白晕（χ2 = 4.893，P = 0.027）出现频率方面差异有统计学意义。玫瑰花瓣征的数量在面部与非面部皮损间（Z = -2.581，P = 0.010）、曝光与非曝光部位皮损间（Z = -2.098，P = 0.036）差异有统计学差异。结论 玫瑰花瓣征最常见于AK；若位于面部或曝光部位的皮损表现出玫瑰花瓣征，且皮肤镜下可见鳞屑、角栓或毛囊口周围白晕，诊断AK的概率显著提高。

Diagnostic value of rosette sign under a polarized dermoscope

Li Weiwei, Wu Wenting, Zhang Hua, Jin Qiuzi, Zhang Qian, Zhang Chunlei Department of Dermatology, Peking University Third Hospital, Beijing 100191, China （Li WW, Wu WT, Jin QZ, Zhang Q, Zhang CL）; Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China （Zhang H）Corresponding author: Zhang Chunlei, Email: zhangchunleius@163.com【Abstract】 Objective To investigate the diagnostic value of rosette sign under a polarized dermoscope. Methods Lesions with rosette sign were selected from polarized dermoscopic image database of the Department of Dermatology of Peking University Third Hospital between September 2014 and March 2017. Then, histopathologically confirmed lesions were further chosen, and the correlations between the rosette sign and diseases were analyzed. These histopathologically confirmed lesions were divided into actinic keratosis（AK） group and non-AK group, and differences in clinical and dermoscopic features were analyzed between the 2 groups. Statistical analysis was carried out by nonparametric test for comparisons of the number of rosette sign between the AK group and non-AK group, as well as between different body sites. Results A total of 4 956 dermoscopic images of skin lesions were analyzed retrospectively, among which there were 144 （2.91%） skin lesions with rosette signs. Among the 144 skin lesions, 74 were histopathologically diagnosed, 37 （50.00%） of which were diagnosed as AK. Compared with the non-AK group, the AK group showed significantly higher proportions of lesions on the face （χ2 = 23.786, P < 0.001）and at sun-exposed sites （χ2 = 12.921, P < 0.001）, and prevalence of superficial scales （χ2 = 7.056, P = 0.008）, keratotic plugs （χ2 = 6.167, P = 0.013） and hair follicle openings surrounded by a white halo （χ2 = 4.893, P = 0.027） under a dermoscope. Moreover, the number of rosette sign was significantly higher in facial lesions than in non-facial lesions （Z = -2.581, P = 0.010）, as well as in lesions at exposed sites than in those at unexposed sites （Z = -2.098, P = 0.036）. Conclusions The rosette sign is mainly observed in AK lesions. If lesions on the face or at sun-exposed sites are characterized by rosette sign, and superficial scales, keratotic plugs and hair follicle openings surrounded by a white halo can be observed under a dermoscope, these lesions can be diagnosed as AK with a high probability.