皮肤镜及高频超声在银屑病指甲检查与评估中的应用

任丹; 王婧宇; 杜治民; 王祎琳; 马冠毅; 饶玮; 赵华

doi:10.3969/j.issn.2095-5227.2023.05.009

皮肤镜及高频超声在银屑病指甲检查与评估中的应用

doi: 10.3969/j.issn.2095-5227.2023.05.009

任丹^1,,
王婧宇¹,
杜治民¹,
王祎琳²,
马冠毅¹,
饶玮¹,
赵华^2, ,

1.
解放军医学院，北京　100853
2.
解放军总医院第一医学中心皮肤科，北京　100853

详细信息

作者简介:
任丹，男，在读硕士，主治医师。研究方向：银屑病。Email: 793675288@qq.com

通讯作者:
赵华，女，主任医师，博士后，副主任。Email: Luckhua@163.com

中图分类号: R758.63
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出版历程
- 收稿日期: 2022-08-03
- 网络出版日期: 2023-05-23
- 刊出日期: 2023-05-28

Application of dermoscopy and high-frequency ultrasound in examination and evaluation of fingernail psoriasis

1.
Chinese PLA Medical School, Beijing 100853, China
2.
Department of Dermatology, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China

More Information

Corresponding author: ZHAO Hua. Email: Luckhua@163.com

摘要

摘要: 背景指甲损害是银屑病的常见临床表现，对病甲进行精准检查和评估是临床诊疗工作的重要环节，但目前缺乏有效的检查与评估手段。目的探究皮肤镜和50 MHz高频超声在银屑病指甲检查和评估中的应用价值。方法选取2021年6月 - 2022年6月于解放军总医院第一医学中心皮肤科诊断的甲银屑病患者35例作为病例组，选取无甲相关疾病、无银屑病家族史人员25例作为对照组。应用甲银屑病严重程度指数(nail psoriasis severity index，NAPSI)评估病情，总结银屑病指甲出现的皮肤镜特征，分析不同皮肤镜特征与病情严重程度的关系。超声测量甲板、甲床的厚度并分析甲板、甲床厚度的组间差异及与病情严重程度的相关性。结果皮肤镜观察到银屑病指甲特征主要有远端甲分离、裂片状出血、甲凹点等。出现甲凹点、甲板脆裂、甲半月红斑、甲下角化、远端甲分离这5种特征的病损甲较无相应特征甲的NAPSI评分更高，差异有统计学意义(P均＜0.05)。超声检查可见银屑病指甲甲板三层结构显影不清晰、甲板凹凸不平、甲下角化过度，测量发现银屑病指甲的甲板、甲床厚度均较对照组增厚，除左手食指、中指、无名指外其余手指甲床厚度与NAPSI总分均呈正相关(r=0.392 ∼ 0.492，P均＜0.05)。结论皮肤镜可精确发现并分析银屑病指甲的病损特征，可作为银屑病指甲的常规检查手段。50 MHz高频超声可以发现银屑病甲形态结构的深层次改变，并可通过测量数据推测病情的严重程度，可用作皮肤镜检查的补充。
- 银屑病指甲 /
- 皮肤镜 /
- 高频超声 /
- 甲银屑病严重程度指数 /
- 甲床厚度
Abstract: Background Nail psoriasis is a common clinical feature of psoriasis. Accurate examination and evaluation of fingernail psoriasis is an important part of clinical work, however, at present effective methods are lacking. Objective To explore the application value of dermoscopy and 50 MHz high-frequency ultrasound in the examination and evaluation of fingernail psoriasis. Methods Thirty-five patients with nail psoriasis diagnosed at the Department of Dermatology of the First Medical Center of Chinese PLA General Hospital from June 2021 to June 2022 were selected as the case group, and 25 cases without nail-related diseases or family history of psoriasis were selected as the control group. The Nail Psoriasis Severity Index (NAPSI) was used to evaluate the severity of psoriatic fingernails, then the dermoscopic features of psoriatic fingernails were summarized, and the relationship between different dermoscopic characteristics and the severity of fingernail psoriasis was analyzed. The thickness of nail plate and nail bed was measured and compared by ultrasound, and the correlation between the thickness of nail plate and nail bed with the severity of psoriatic fingernails was analyzed. Results The main dermoscopic features were subungual hyperkeratosis, splinter hemorrhages and pitting. The NAPSI of psoriatic fingernails with pitting, crumbling, red spots in the lunula, subungual hyperkeratosis and onycholysis were higher than the fingernails without these features (all P < 0.05). Ultrasound examination showed that the three-layer structure of the psoriatic fingernails plate were not clear, the plate became uneven and subungual hyperkeratosis. The thickness of the psoriatic nail plate and nail bed were thicker than that of the control group. The nail bed thickness was positively correlated with total NAPSI score for all fingers except the left index, middle and ring fingers (r=0.392-0.492, all P＜0.05). Conclusion Dermoscopy can accurately detect and analyze the characteristics of psoriatic fingernails, and can be used as a routine examination method. 50 MHz high-frequency ultrasound can detect the deep changes in the morphological structure of psoriatic fingernails and predict the severity by measuring data, which can be used as a supplement for dermoscopy.
- fingernail psoriasis /
- dermoscopy /
- high frequency ultrasound /
- nail psoriasis severity index /
- nail bed thickness

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图 1 银屑病指甲皮肤镜特征

A：甲凹点；B：甲碎裂；C：白甲；D：甲半月红斑；E：裂片状出血；F：甲下毛细血管扩张；G：远端甲分离；H：油斑；I：甲下角化过度；J：甲纵脊

Figure 1. Dermoscopic features of fingernail psoriasis

A: Pitting; B: Crumbling; C: Leukonychia; D: Red spots in the lunula; E: Splinter hemorrhages; F: Subungual angiotelectasis; G: Onycholysis; H: Oil drop sign; I: Subungual hyperkeratosis; J: Longitudinal ridge

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图 2 正常指甲超声图像

甲板为背侧及腹侧甲板共同组成的三层结构(黄色箭头)；甲床为腹侧甲板下方低回声区域(蓝色双箭头)；甲基质为甲床近端的浅灰色区域(红色三角)

Figure 2. Ultrasonic image of normal fingernail

The nail plate is a three-layer structure consisting of the dorsal and ventral plate (yellow arrows); the nail bed is the hypoechoic region under the ventral plate (double blue arrows); the nail matrix is the soft gray region at the proximal end of the nail bed (red triangle)

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图 3 银屑病指甲超声及皮肤镜特征

A：甲板凹凸不平(黄色三角)；B：甲板增厚、显影不清晰；C：甲下角化过度(黄色箭头)

Figure 3. Ultrasonic features of the fingernail psoriasis

A: Uneven nail plate (yellow triangles); B: Thickened and fuzzy nail plate; C: Subungual hyperkeratosis (yellow arrows)

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表 1 两组研究对象一般资料比较

Table 1. Comparison of general information between the two groups

指标	病例组(n=35)	对照组(n=25)	χ²/t值	P值
年龄/岁	45.2 ± 14.8	45.4 ± 20.2	0.045	0.965
性别(男/女)/例	24/11	17/8	0.002	0.963

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表 2 出现与不出现特定皮肤镜特征银屑病指甲NAPSI评分比较[Md(IQR)]

Table 2. Comparison of NAPSI between the psoriatic fingernails with or without dermoscopic feature (Md[IQR])

皮肤镜特征	有特征组(NAPSI)	无特征组(NAPSI)	Z值	P值
甲凹点	4.0(3.0~5.0) (n=124)	3.0(2.0~5.0) (n=153)	-4.822	＜0.001
甲碎裂	5.0(4.0~6.0) (n=109)	3.0(2.0~4.0) (n=168)	-8.340	＜0.001
甲半月红斑	4.0(4.0~6.0) (n=30)	4.0(2.0~5.0) (n=247)	-3.360	0.010
甲下角化过度	4.0(4.0~6.0) (n=65)	4.0(2.0~5.0) (n=212)	-3.972	＜0.001
远端甲分离	4.0(3.0~6.0) (n=145)	3.0(2.0~4.0) (n=132)	-4.832	＜0.001
油斑	4.0(3.0~5.0) (n=115)	4.0(2.0~5.0) (n=162)	-1.783	0.075
裂片状出血	4.0(2.0~6.0) (n=138)	4.0(2.0~5.0) (n=137)	-1.844	0.065
甲下毛细血管扩张	3.5(2.0~5.0) (n=36)	3.5(2.0~5.0) (n=241)	-1.069	0.285

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表 3 甲板甲床厚度的三组比较[mm，Md(IQR)]

Table 3. Comparison of nail plate and nail bed thickness between the three groups (mm, Md[IQR])

厚度	病例组病损甲	病例组非病损甲	对照组甲	H值	P值
甲板厚度	0.43(0.37~0.51) (n=269)	0.39(0.35~0.45)^a (n=73)	0.37(0.33~0.43)^a (n=249)	58.791	＜0.001
甲床厚度	1.81(1.60~2.06) (n=264)	1.52(1.33~1.69)^a (n=73)	1.47(1.26~1.70)^a (n=248)	142.792	＜0.001
^aP＜0.05，vs 病例组病损甲。

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表 4 病损甲与对照甲十指间甲板、甲床厚度比较

Table 4. Comparison of nail plate and nail bed thickness of ten fingernails between the psoriatic fingernails group and the control group

指甲	甲板厚度/mm				甲床厚度/mm
指甲	病例组病损甲	对照组甲	t值	P值	病例组病损甲	对照组甲	t值	P值
左Ⅰ	0.53 ± 0.10 (n=29)	0.46 ± 0.09 (n=25)	2.708	0.009	2.02 ± 0.40 (n=28)	1.54 ± 0.27 (n=25)	5.067	＜0.001
左Ⅱ	0.47 ± 0.10 (n=29)	0.40 ± 0.07 (n=25)	3.112	0.002	1.78 ± 0.28 (n=28)	1.43 ± 0.27 (n=25)	4.665	＜0.001
左Ⅲ	0.43 ± 0.07 (n=28)	0.36 ± 0.05 (n=25)	4.210	＜0.001	1.98 ± 0.34 (n=27)	1.58 ± 0.24 (n=25)	4.780	＜0.001
左Ⅳ	0.38 ± 0.07 (n=30)	0.34 ± 0.05 (n=25)	2.356	0.022	1.81 ± 0.30 (n=29)	1.61 ± 0.23 (n=25)	2.641	0.011
左Ⅴ	0.36 ± 0.06 (n=20)	0.31 ± 0.06 (n=25)	2.956	0.005	1.52 ± 0.26 (n=20)	1.19 ± 0.20 (n=25)	4.719	＜0.001
右Ⅰ	0.54 ± 0.08 (n=29)	0.46 ± 0.08 (n=25)	3.368	0.001	2.04 ± 0.38 (n=29)	1.62 ± 0.30 (n=23)	4.358	＜0.001
右Ⅱ	0.50 ± 0.08 (n=27)	0.40 ± 0.07 (n=25)	4.562	＜0.001	1.85 ± 0.31 (n=27)	1.44 ± 0.21 (n=25)	5.516	＜0.001
右Ⅲ	0.45 ± 0.08 (n=24)	0.38 ± 0.06 (n=25)	3.649	0.001	1.99 ± 0.34 (n=24)	1.59 ± 0.20 (n=25)	5.011	＜0.001
右Ⅳ	0.40 ± 0.05 (n=30)	0.34 ± 0.05 (n=25)	3.726	＜0.001	1.82 ± 0.35 (n=30)	1.56 ± 0.25 (n=25)	3.319	0.003
右Ⅴ	0.36 ± 0.06 (n=23)	0.33 ± 0.06 (n=24)	1.694	0.097	1.54 ± 0.28 (n=22)	1.16 ± 0.22 (n=25)	5.176	＜0.001

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表 5 病例组十指甲床厚度与NAPSI总分相关性

Table 5. Correlation between nail bed thickness of ten fingernails and total NAPSI scores in the psoriatic fingernails group

指甲甲床	r值	P值
左Ⅰ(n=32)	0.393	0.026
左Ⅱ(n=34)	0.276	0.114
左Ⅲ(n=34)	0.248	0.157
左Ⅳ(n=35)	0.262	0.135
左Ⅴ(n=32)	0.415	0.018
右Ⅰ(n=34)	0.466	0.005
右Ⅱ(n=35)	0.419	0.012
右Ⅲ(n=32)	0.481	0.003
右Ⅳ(n=34)	0.392	0.022
右Ⅴ(n=33)	0.492	0.004

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