与结核相关的脂膜炎研究进展题录

脂膜炎病因繁多而复杂, 感染为重要病因之一, 在欧美等结核低发区, 以链球菌感染最为常见, 但在结核高发地区如我国, 结核杆菌感染是脂膜炎的重要因素, 以Bazin硬红斑和结节性红斑最为常见。Bazin硬红斑与结核关系最为密切, 常表现为下肢屈侧结节、斑块, 可出现溃疡, 病理表现为小叶性脂膜炎。结节性红斑可作为结核的早期症状出现, 可作为结核的预测指标, 常表现为双下肢伸侧红斑、结节, 极少破溃, 间隔性脂膜炎是其病理特征。Bazin硬红斑和结节性红斑的抗结核治疗常可取得理想效果。因此, 明确结核分枝杆菌与脂膜炎的关系, 在脂膜炎的治疗及预后方面, 尤其在结核高发地区有着重要意义。     

33例脂膜炎与结核感染相关性分析

 目的 了解不同类型的脂膜炎患者与结核感染的相关性。方法 纳入2019年1月—2021年12月就诊于常德市第一人民医院33例脂膜炎患者的临床资料,对其临床特征、病理特征、与结核感染的相关性、治疗情况及随访情况进行分析。结果 ①33例脂膜炎患者中,结节性红斑24例,硬红斑9例,男女比例为1 ∶ 4.5,平均年龄46岁,平均病程10个月。②临床发病部位集中在四肢,均伴有疼痛。30例（90.91%)表现为红斑、结节、肿胀,其中1例硬红斑（3.03%）出现溃疡。6例(18.18%)出现发热、咳嗽、盗汗。2例硬红斑患者同时伴有或先后出现丘疹性坏死性结核疹,2例结节性红斑患者伴有全身多关节疼痛。③22例（66.67%,包括9例硬红斑、13例结节性红斑)伴结核分支杆菌潜伏感染（LTBI）。硬红斑患者结核感染阳性率高于结节性红斑患者（P＝0.020）。④皮损组织病理表现为间隔性脂膜炎11例、小叶性脂膜炎3例、混合性脂膜炎19例。与结核感染相关的22例脂膜炎患者病理下多可见上皮细胞肉芽肿、多核巨细胞以及干酪样坏死,其余11例均可见真皮层血管周围及脂肪间隔淋巴细胞浸润,且均未见上皮样肉芽肿及多核巨细胞。33例患者抗酸染色、PAS染色、直接免疫荧光均未见阳性表现。⑤22例与结核感染相关患者中,接受抗结核治疗15例,治愈率为68.18%,拒绝接受抗结核治疗患者7例,治愈率为14.29%。11例结核感染不相关患者采用免疫调节联合治疗,治愈率为100%。所有患者均未出现严重药物不良反应。结论 硬红斑患者的结核感染阳性率比结节性红斑患者高。在结核感染相关的脂膜炎患者中,接受抗结核治疗者治愈率比免疫调节联合治疗者高;对于未发现结核感染证据的结节性红斑,免疫调节治疗可能有效。结节性红斑患者的发病原因可能与结核感染相关。在结核高发地区,结节性红斑患者完善相关筛查极其重要。     

结核相关结节性红斑的研究进展

结节性红斑(erythema nodosum,EN)是一种常见的间隔性脂膜炎,以红斑、炎症性皮下结节为主要表现。其病因复杂,目前认为部分EN与结核菌感染关系密切。结核相关EN好发于女性及青少年,最常见的结核病类型是原发型结核和淋巴结结核,但大多数患者缺乏相应结核病表现。其发病机制认为与免疫复合物介导的以及细胞介导的免疫机制有关。EN主要根据皮损病理诊断确诊,其组织学表现为不伴血管炎的间隔性脂膜炎,多有间隔增厚,伴各种炎性细胞浸润。当怀疑结核菌感染时,则需完善结核菌素试验、结核抗体、胸片、痰培养等相关检查以明确诊断。认为即使缺乏明确的结核感染证据,对于结核菌素皮肤试验强阳性的患者,尤其是在结核流行病区,应该进行抗痨治疗。     

结节性脂膜炎误诊1例

患者男 ,2 3岁。因右眼肿痛、视力减退 4月余 ,全身皮肤肿痛伴发热 6天入院。 4月前无明显诱因出现右眼肿痛 ,视物模糊 ,头颅ＣＴ示右眼周围组织肿胀 ,球后脂肪模糊 ,视神经及眼外肌肿胀 ,颅内正常。 3次局部穿刺活检病理诊断均为炎性改变。曾多次在外院就诊 ,分别诊断为“右眼眶周围蜂窝织炎”或“右眼眶炎性假瘤”。先后选用多种抗生素治疗 3月余无效。近 6天来右眼肿痛加剧且出现全身皮肤肿痛。体检 :Ｔ39℃ ,Ｐ10 0次 /ｍｉｎ ,呼吸 2 2次 /ｍｉｎ ,血压 14 .6 3/ 9.31ｋＰａ。全身皮肤明显肿胀 ,轻压痛 ,四肢、躯干皮下可触及大小不等…     

系统性结节性脂膜炎1例

系统性结节性脂膜炎１例王剑春，曾抗，单雨文，谭仲楷第一军医大学南方医院（邮政编码５１０５１５）系统性结节性脂膜炎（ＳＮＰ）即系统性Ｗｅｂｅｒ一名Ｃｈｒｉｓｔｉ。ｎ病，十分少见，除皮［：组织发生结节性非化脓性炎症外，内脏也可受到广泛损害，预后险恶［‘ｊ...     

结节性脂膜炎误诊分析

结节性脂膜炎(nodular panniculitis),又称Weber-Christian病,是一种临床上较少见的皮下脂肪组织非化脓性炎症性疾病.往往因其临床表现不典型而易被误诊[1].我院自1983年以来收治并经病理检查证实的结节性脂膜炎患者共28例,其中18例在确诊前曾被多次误诊,误诊率为64.3%.现将误诊情况分析如下.     

结核相关性脂膜炎临床及组织病理分析

目的分析结核相关性脂膜炎的临床及组织病理特点,探讨结核感染与脂膜炎发病的关系。方法回顾性分析我科2011年1月—2013年8月252例组织病理明确诊断为脂膜炎的患者临床及组织病理资料,并根据结核菌素皮试(TST)结果及其阳性反应级别分为PPD阴性组及PPD阳性组,其中PPD阳性组又分为PPD 1+、PPD 2+、PPD 3+3组。再根据T-SPOT.TB结果分为T-SPOT.TB阴性组及T-SPOT.TB阳性组,对比分析各组间患者临床及组织病理特点。结果 PPD阳性组与PPD阴性组患者组织病理改变在表皮、脂肪层受累、炎性浸润细胞类型、有无上皮样肉芽肿方面对比差异具有统计学意义(P0.05);不同PPD阳性级别组患者的组织病理特点差异无统计学意义(P0.05);T-SPOT.TB阴性组与阳性组患者组织病理改变差异无统计学意义(P0.05)。结论皮肤脂膜炎的发病与结核感染密切相关,PPD检测阳性及皮损组织病理中出现脂肪层以小叶受累或混合型炎症、以上皮样和(或)多核巨细胞浸润为主以及上皮样肉芽肿是脂膜炎与结核感染相关的线索。     

结节性脂膜炎78例临床分析

总结了78例经病理证实的脂膜炎患者的临床资料。本病多发生在中青年女性,分皮肤型和系统型,主要的临床表现有发热(70.51%)、关节痛(66.67%)、皮下浸润性伴有自觉痛及触痛的结节或斑块(100%)。系统型病人可伴有呼吸、循环、消化系统脏器受累及实验室检查改变。对其诊断名称、病因、早期诊断、易误诊疾病的鉴别诊断等进行了探讨。认为此病临床上并非罕见,可因其临床表现多样化不被认识而误诊,因而临床上对中青年女性、不明原因发热伴非游走性关节疼痛、皮下出现伴有自觉痛及触痛的浸润性结节或斑块应高度警惕脂膜炎的可能,须早期行病理检查。     

亚急性结节性游走性脂膜炎

亚急性结节性游走性脂膜炎赵玉明，温树田，高广荣（通化市卫校皮肤科１３４００１）患儿男性，１周岁。于１９８６年６月１０日就诊。双小腿皮疹三个月，右面部皮疹１０天。于１９８６年３月１５日突然发现双腿窝处各起指头大皮下结节一个。开始皮色，逐渐变成红色，最后...     

下肢红斑结节性疾患的临床及组织学观察

本文对最常见的下肢结节性疾患中,结节性红斑,硬结性红斑,结节性血管炎三种疾患共120例,进行了临床的及实验室的检查,并对三者之间的相互关系进行了讨论。     

Erythema induratum of bazin

Erythema induratum of Bazin is a chronic, nodular eruption that usually occurs on the lower legs of young women. It has been regarded as a manifestation of tuberculin hypersensitivity, a type of tuberculid occurring on the legs, whereas nodular vasculitis represents the nontuberculous counterpart. The number of reports of erythema induratum of Bazin is decreasing in most developed countries in accordance with the decreased incidence of tuberculosis. The etiopathogenesis of erythema induratum of Bazin and its relation to tuberculosis are still controversial, because mycobacteria cannot be cultured from the skin lesions. Most authors currently consider erythema induratum of Bazin (nodular vasculitis) a multifactorial disorder with many different causes, tuberculosis being one of them.     

结节性红斑与硬结性红斑皮损原位抗原研究

采用ＰＡＰ法对结节性红斑、慢性游走性结节性红斑、硬红斑及结节性血管炎４种疾病共３５例的原位抗原进行检测。结果在血管的检出例数分别为１１／１２，８／８，８／８，６／７；在胶原纤维表面的检出例数分别为１１／１２，７／８，８／８，６／７；所有病例表皮角朊细胞内均能检出；在血管腔内与血管腔外的红细胞表面的检出例数除慢性游走性结节性红斑为５／８外，其余病种均能检出。提示结节性红斑等４种疾病均为存在免疫复合物     

Erythema induratum Bazin nach Lungentuberkulose

Summary: Mycobacterium tuberculosis can be directly demonstrated in lesions of cutaneous tuberculosis, but mostly could not be demonstrated in Tuberculids. These include erythema induratum of Bazin, papulonecrotic tuberculid as well as lichen scorphulosorum. Tuberculids result from the hematogenous spread of Mycobacteria tuberculosis in a person with a high degree of immunity. We report on a 63‐year‐old woman with erythema induratum of Bazin and pulmonary tuberculosis in medical history, with hightened tuberculin sensitivity and negative bacterial cultures. Polymerase chain reaction (PCR) could not detect Mycobacterium tuberculosis‐specific DNA. After eight weeks only, the patient responded well to a course of antituberculosis therapy (isoniazid, ethambutol, rifampicin and pyracinamide) with marked resolution of the lesions. The tuberculous origin of erythema induratum of Bazin is still controversal, since mycobacteria cannot be cultured from skin lesions. Since the availability of PCR‐diagnostic, in some cases, but not in our patient, PCR was positive für Mycobacterium tuberculosis‐specific DNA. The good response to antituberculosis therapy is a further argument for the association of erythema induratum of Bazin and Mycobacterium tuberculosis     

Cutaneous tuberculosis: epidemiologic,etiopathogenic and clinical aspects - Part I

Cutaneous tuberculosis (CTB) is the result of a chronic infection by Mycobacteriumtuberculosis, M. ovis and occasionally by the Calmette-Guerin bacillus. The clinicalmanifestations are variable and depend on the interaction of several factorsincluding the site of infection and the host''s immunity. This article revises thecurrent knowledge about this disease''s physiopathology and immunology as well asdetailing the possible clinical presentations.     

Cutaneous tuberculosis: diagnosis,histopathology and treatment - Part II

The evolution in the knowledge of tuberculosis'' physiopathology allowed not onlya better understanding of the immunological factors involved in the diseaseprocess, but also the development of new laboratory tests, as well as theestablishment of a histological classification that reflects the host''s abilityto contain the infectious agent. At the same time, the increasing bacilliresistance led to alterations in the basic tuberculosis treatment scheme in2009. This article critically examines laboratory and histologicalinvestigations, treatment regimens for tuberculosis and possible adversereactions to the most frequently used drugs.     

Chronic recalcitrant erythema nodosum leprosum: therapeutic dilemma and role of mycobacterium indicus pranii vaccine

Erythema nodosum leprosum is a severe immune reaction that complicates the usual course of multibacillary leprosy. There is increased activation of T-cells in erythema nodosum leprosum. Treatment modalities available to date for the management are systemic steroids, thalidomide, methotrexate, cyclophosphamide, azathioprine, minocycline, and apremilast but none of them is promising and safe. Mycobacterium indicus pranii is an atypical mycobacterium possessing strong immunomodulatory properties. The vaccine for this mycobacterium has been shown to have both immunotherapeutic and immunoprophylactic effects in multibacillary leprosy patients. We report a case of chronic recalcitrant erythema nodosum Leprosum which responded to Mycobacterium indicus pranii vaccine without any adverse effects, thereby suggesting its role as a novel therapeutic option in this reaction.