目的探讨黄褐斑分期的评价指标。
方法收集黄褐斑患者195例，根据近期皮损面积扩大、颜色加深、皮损泛红、搔抓后皮损变红、玻片压诊有褪色将黄褐斑分为活动期和稳定期。用反射式共聚焦显微镜(RCM)、皮肤镜、Mexameter18、LAB分光测色计检测两期黄褐斑患者皮损，比较两者差异。
结果195例患者中，活动期115例占59.0 %、稳定期80例占41.0 %。活动期RCM下树突状黑素细胞活跃度(DMA)35.08±10.59高于稳定期15.06±9.20；RCM下炎症细胞、皮肤镜下血管数量多于稳定期；红斑指数(EI)376.35±61.39高于稳定期320.36±62.40；A值13.28±1.75高于稳定期12.34±1.78；两期比较差异有统计学意义(均 P<0.05)。而两期皮损处黑素数量、黑素指数(MI)、L值与B值比较，差异无统计学意义( P>0.05)。
结论可依据临床表现将黄褐斑分为活动期与稳定期。DMA、炎症细胞、血管数量、EI值、A值可作为分期参考指标。
ObjectiveTo investigate the evaluation index of melasma staging by clinical manifestations and non-invasive skin detection technology.
MethodsA total of 195 patients with a clinical diagnosis of melasma were enrolled from the First Affiliated Hospital of Kunming Medical University. The skin with lesion enlarged, color darker, erythema, red occured after scratching or lesion faded after compressing with glass belonged to the active stage; on the contrary, it was in the stable stage. Reflectance confocal microscopy (RCM), dermoscopy, Mexameter 18 and LAB were used to observe skin lesions of different stage of melasma.
ResultsThere were 115 patients (59.0 %) in the active stage of melasma and 80 patients (41.0 %) in the stable stage. DMA score in active stage 35.08±10.59 were significantly higher than that of the stable stage 15.06±9.20 ( P<0.05). There were statistically significant difference in the quantity of inflammatory cell and blood vessels between two stages of melasma ( P<0.05). Erythema index (EI) in active stage of melasma 376.35±61.39 were higher than that of the stable stage 320.36± 62.40 ( P<0.05). A-value in active stage of melasma 13.28±1.75 were higher than that of the stable stage 12.34± 1.78 ( P<0.05). However, there were no siginificant differences in the quantity of melenin, melanin index (MI) , L-value and B-value.
ConclusionsMelasma could be divided into active stage or stable stage, respectively, according to its clinical manifestations. DMA score, quantity of inflammatory cells and blood vessels, EI and A-value could be used as the reference index of melasma staging.
张琼予,孙东杰,涂颖,等. 黄褐斑的临床分期[J]. 中华医学美学美容杂志,2018,24(4)：274-278.
DOI:10.3760/cma.j.issn.1671-0290.2018.04.017版权归中华医学会所有。
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