【作者】 孙兆伟；

【导师】 徐丽敏； 肖尹；

【作者基本信息】 天津医科大学 ， 皮肤病与性病学， 2010， 硕士

【摘要】 目的：1.通过共聚焦激光扫描显微镜采集脂溢性角化病和扁平疣图像,探讨脂溢性角化病和扁平疣的CLSM图像特征。为临床对脂溢性角化病和扁平疣影像学诊断提供可靠依据。2.利用CLSM评估他扎罗汀凝胶联合NB-UVB治疗斑块型银屑病的治疗效果。方法：1.通过对经组织病理学确诊的脂溢性角化病和扁平疣的图像分别进行分析,归纳各自相应的特异性诊断指标,并在盲态下采用回顾性分析方法分别对所有图像进行判读,评价CLSM诊断的特异性和敏感性。同时对脂溢性角化病和扁平疣患者CLSM诊断准确率与病理诊断的准确率相比较。2.利用CLSM分别检测PIS评分、表皮厚度和迂曲毛细血管治疗前后数量变化,评估联合他扎罗汀凝胶和NB-UVB治疗斑块型银屑病是否优于单一NB-UVB治疗结果：1.脂溢性角化病和扁平疣的CLSM图像特征和病理图像具有较高的一致性,经卡方检验证实：CLSM脂溢性角化病特异性指标为“脑回状”结构、棘层肥厚、角囊肿。扁平疣的特征性指标为“花团状”结构和空泡细胞。CLSM诊断脂溢性角化病灵敏度为100%,特异度为87.5%,CLSM对扁平疣的诊断灵敏度为89.7%,特异度为90.9%。2..联合他扎罗汀NB-UVB和单一NB-UVB治疗斑块型银屑病均有效,前者的PIS评分和表皮厚度减少量均优于后者。结论：1.CLSM对脂溢性角化病和扁平疣诊断和鉴别诊断具有较高的灵敏性和特异性。2.联合他扎罗汀凝胶和NB-UVB治疗斑块型银屑病疗效优于单一NB-UVB治疗。更多还原

【Abstract】 Objective:1.The aim of the study was to test the applicability of CLSM to the diagnostic discrimination of Seborrheic keratosis and Plane warts.And their architecture aspects observed by Confocal laser scanning microscopy, and to correlate them with routine histopathology.2.Evaluate the therapeutic efficacy of narrow-band UVB phototherapy in combination with topical tazarotene.to plaque psoriasis.by confocal laser scanning microscopy.Method:1.Images of CLSM were contrasted with the histopathology to induce the criteria. Blinded retrospective analysis of the images from the lesions was carried out by the criteria to determine the specificity and sensitivity for diagnosis.2.Efficacy was assessed separately by means of a modified psoriasis severity index (PSI).The thickenesses of epidermis and amount of capillary were measured before and after the Phototherapy. Aimed to asess whether the addition of tazarotene to narrow-band UVB phototherapy more effective, faster clearing of psoriasis compared with NB-UVB monotherapyResults:1.There was a good correlations between the seborrheic keratosis and Plane warts dermoscopic patterns and findings of confocal images.Byχ2 test, multivariate discriminant analysis and binary logistic regression were performed for the identification of the significant features and for testing newly created diagnostic models. Seborrheic keratosis were mostly characterized by"Gyrus-like"structure、acanthosis、horn cysts.Plane warts were mostly characterized by"Flowers-like" Structure and vesicular cell. the sensitivity and specificity of confocal features for the diagnosis of seborrheic keratosis were 100% and 87.5%.the sensitivity and specificity of confocal features for the diagnosis of plane warts were 89.7% and 90.9%.2.Both treatment modalities notably reduced the PSI scores and the thickness with values being significantly lower in skin areas.But the addition of tazarotene to narrow-band UVB phototherapy more effective, faster clearing of psoriasis compared with NB-UVB monotherapy.Conclusion:1.there are high sensitivity and specificity of confocal features for the diagnosised of seborrheic keratosis and plane warts.2.The addition of tazarotene to narrow-band UVB phototherapy promotes more effective, faster clearing of psoriasis compared with NB-UVB monotherapy更多还原