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Identifizierung von fleckigen Psoriasis und Pityriasis rosae durch Zellen in Ausschlag Bereich mit transparentem Klebeband Peeling

06/13/2019

Psoriasis ist eine polygene, immunvermittelte, chronisch, rezidivierender entzündliche Haut disease.Drip Psoriasis ist eine der Psoriasis vulgaris, und ihre klinischen Manifestationen sind vor allem Erythem, Papeln und scales.The Ätiologie von pityriasis roseum ist nicht klar,, und einige Wissenschaftler denken, dass es auf die Infektion von humanen Herpesvirus Typ verwandt ist 6 (HHV-6) und humane Herpesvirus Typ 7 (HHV7), which is also a erythema papular and squamous skin disease.Both psoriasis droplet and pityriasis rosacea occur in the trunk and have many similarities to the naked eye.Typical pitchoriasis and pityriasis rosae are easy to identify, Ersteres hat die Eigenschaften des Wachses Abschaben Phänomen, Membran-Phänomen und punctata Blutungen, und der lange Achse des letzteren Ausschlags ist mit der Richtung der Haut Korn konsistent, und ein Teil der pityriasis rosae können mit der Mutter identifiziert werden spot.However, es ist schwierig, die atypischen Tröpfchen Psoriasis und die atypische pityriasis rosae mit bloßem Auge zu unterscheiden, so dass die pathologische Untersuchung von Hautgewebe ist ein wertvolles diagnostisches method.However, Die pathologische Untersuchung des Hautgewebes ist ein gewickelter Abtastverfahren, und die Patienten-Compliance ist poor.We diese beiden Krankheiten nach verschiedenen Arten von zytologischen Hautausschlag Oberfläche von Psoriasis Tröpfchen identifiziert und Pityriasis rosacea, and used non-invasive sampling method to paste skin exfoliated cells in skin rash area with transparent tape, and the experimental results were satisfactory.

  1. Psoriasis-Therapie-Forschung Daten und Methoden

1.1 Research object

The study subjects were all patients who went to the dermatology department of our hospital from September 2015 to December 2016, and conducted histopathological examination on skin lesions of patients with atypical psoriasis and patients with pityriasis rosacea, and signed informed consent forms.Thirty patients with psoriasis punctiform and pityriasis rosaceae were selected, einschließlich 18 males and 12 females in the psoriasis group (age 39.50±21.55).Dort gab es 14 males and 16 females in the pityriasis group, aged 32.33±23.75.The gender composition ratio and age of the two groups were comparable.

1.2 Reagents and materials

HE dye solution, the primary antibody was mouse anti-human granulocyte myeloperoxidase antibody, the secondary antibody was horseradish peroxidase-labeled rabbit anti-rat IgG polyclonal antibody, and diaminobenzidine (DAB) was the substrate color developing kit, all purchased from Bio Genex company in the United States.EAF fixing solution configuration: take 5mL glacial acetic acid, 40% formaldehyde 10mL, anhydrous ethanol to 100mL.

1.3 Method

1.3.1 Specimen collection

The patients in both groups were pasted on the rash site with commercial transparent adhesive tape, and then removed and discarded after 3s (removing dry cells from the surface). Then three adhesive tapes were pasted on the same site for experimental use.The tapes with specimens were stained with HE (removal of the first 2 steps of xylene dewaxing) and stained with immunohistochemistry, und das Gewebe war Zytologie performed.At gleichzeitig von Peeling-Zellen für jeden Patienten Probenahme, Nicht-transparente Klebebänder der beiden Gruppen von Patienten wurden auf dem Hautausschlag Bereich klebt eine Stelle auszuwählen, die für die Haut histopathologischen Untersuchung, und HE-Färbung wurde durchgeführt,.

1.3.2 Probe

Mit HE-Färbung, Klebeband mit abgetrennten Zellproben wurde auf dem Objektträger fixiert, und die Proben und Marker wurden mit der Zellseite up.One der Proben erfolgte mit festen 95% Alkohol, und modifizierte Verfahren HE-Färbung, nämlich, die Färbemethode der zervikalen Epidermiszellen, wurde adoptiert. Nach dem Entwässern und Transparenz, neutral Gummi wurde unter dem Lichtmikroskop beobachtet und versiegelt.

1.3.3 immunhistochemische Färbung

Die verbleibenden zwei Proben wurden mit EAF Fixateur fixiert bei 4 ℃ für 15min, mit PBS gewaschen, und betrieben nach dem Kit instructions.One Probe wurde als Blindkontrolle verwendet, und die andere Probe wurde mit DAB behandelt und HE Wiederfärbung für 40s respectively.Dye und entwässern, und Abdichten mit neutralen Harz für die Beobachtung unter dem Lichtmikroskop.

1.3.4 Hautproben

Siehe Histopathologie Arbeitsweise von HE-Färbung.

1.4 Standard der Diagnose

In der HE-Färbung Ergebnisse der Bandproben, Zelltypen wurden von der Kernmorphologie unter optischem Mikroskop bestimmt, und die Kerne als Lappen oder Stäbchen präsentiert wurden als Neutrophile beurteilt, während der runden oder waren fast runde Kerne Plattenepithel-Zellen der Haut, das entspricht Keratinozyten oder körnige Schichtzelle in der Kutikula der pathologischen HE Methode der Hautfärbung tissue.Meanwhile, die Verteilung von Neutrophilen war observed.Microscopically, neutrophils with clustered distribution were positive and diagnosed as psoriasis.The absence of neutrophils or the presence of a small number of scattered neutrophils was negative.If neutrophils were found to be clustered in the exfoliated cells, the results were positive and the psoriasis was diagnosed as droplet psoriasis.If the diagnosis was not cluster distribution (scattered distribution of neutral cells + no neutral cells), the result was negative and the diagnosis was pityriasis rosea.The diagnosis of transparent adhesive tape method in the diagnosis of psoriasis (%) = a/(a + b), pityriasis rosea diagnostic rate (%) = d/(c + d), overall diagnostic accuracy (%) = (a + d)/(a + b + c + d).

1.5 Statistical treatment

SPSS13.0 software was used to compare the coincidence rate of the diagnosis results of scotch tape with the histopathological HE staining and the distribution of neutrophils in the two groups. The differences were statistically significant with P < 0.05.

 

  1. Psoriasis-Therapie-Forschung Ergebnisse

2.1 Scotch tape

The distribution of neutrophils in skin lesions of the two groups was shown in table 1, and the comparison of diagnosis rate of shedding cells and histopathological diagnosis was shown in table 2. The incidence of neutrophils in the two groups was statistically significant (chi-square =52.50, P < 0.01).After HE staining, the distribution of detached cells under the microscope was shown in figure 1 ~ 3.

 

 

 

 

 

 

 

 

 

 

 

 

2.2 Immunohistochemical staining results

Neutrophils were further confirmed to be neutrophils because neutrophils contain myeloperoxidase.

2.3 Comparison of diagnostic coincidence rate

Are shown in table 2.The coincidence rate of the transparent tape cell method was 93.33% und 100.00%, beziehungsweise, and the total diagnostic accuracy was 96.67%.

 

  1. Psoriasis Diskussion der Behandlung Forschung

Demodex scabies, sarcoptic mange and superficial fungi have been used for many years.However, it is rarely reported that skin diseases are diagnosed by pasting skin exfoliated cells with scotch tape.In recent years, Chinese scholars Chen xiangming et al. took the lead in the study of using transparent tape to paste epidermal exfoliated cells in the rash area to distinguish atypical patchy psoriasis from atypical numeral eczema, and obtained satisfactory results in a small sample.In this study, detached cells in rash area were used to identify atypical pityriasis and atypical pityriasis rosacea.We know that no matter in advanced psoriasis or static psoriasis, the most key and specific histopathological characteristics of psoriasis skin lesions of all types are neutrophils aggregation in the upper part of keratinosis, namely Muro microabscess, and Muro microabscess in drip psoriasis can be hump-like.The mechanism of Muro microabscess is closely related to the chemotaxis of neutrophils induced by il-8.The unique histopathological characteristics of Muro microabscess provide theoretical and experimental basis for the diagnosis of psoriasis by skin exfoliation cell method with adhesive tape.However, focal keratinosis was found in the epidermal layer of furyriasis rosea histopathologically, and there was usually no Munro microabscess formation, which was also confirmed in the transparent adhesive strip cell exfoliation method of patients diagnosed with furyriasis rosea histopathologically.

Histopathological diagnosis of psoriasis punctate and pityriasis rosae was the gold standard for the diagnosis of the two diseases (i.e., the diagnostic rate was 100.00%).The results showed that the diagnostic rate of psoriasis was 93.33%(28/30) and pityriasis rose was 100.00% (30/30), with a total accuracy of 96.67%.The results show that the method is very close to the gold standard diagnostic method, which indicates that the study has important clinical application value.

in dieser Studie, immunohistochemistry confirmed that all the rod nuclei and lobulated nuclei of these clusters were neutrophils, indicating that HE staining method can be used independently for the characterization of neutrophils, so that immunohistochemistry staining is not necessary in clinical practice, which can significantly reduce the testing cost.About 2 cases of neutrophils in patients with psoriasis guttata with a scattered distribution, it may be related with the paste adhesive tape from skin rashes, not stick to neutrophils in parts of the cluster area, or with a disposable materials just paste the parakeratosis layer, and the omission of the following is a microabscess Muro layer, so suggest paste 2 times in a row, the rash area may improve the positive rate.In addition to psoriasis, psoriasis somalis, pyoderma, Pusteln, candidiasis, seborrhoische Dermatitis, and syphilis, neutrophils infiltrate the epidermal stratum corneum.However, these diseases can be identified in clinical manifestations and other laboratory tests and are not within the scope of this study.

The skin exfoliating cell method of skin rash sticking with transparent tape is applicable to exclude other similar skin diseases only when the difference between atypical psoriasis and atypical pityriasis rosea is not possible.Although the exfoliated cells diagnostic method is not able to see the pathological conditions of epidermis, dermis and subcutaneous tissues longitudinally like the skin histopathology, it has the advantages of simple operation, low test cost and high patient compliance, so it has further research and application value.

 

  1. Psoriasis-Behandlung Forschung Fazit

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