背景:组织病理学血管炎常出现在溃疡周围标本中,但是这一发现的频率和临床意义尚未得到评估。
目的:我们评估了灵敏度,特异性,负预测值,和组织病理学血管炎的阳性预测价值从溃疡周围边缘检测由于皮肤血管炎的溃疡。
方法:我们对2009年至2016年三级医院的腿部溃疡患者进行了回顾性分析。组织病理学切片由2位对溃疡的病因不了解的皮肤病理学家进行评估。局灶性血管炎定义为累及少于3条血管。
结果:在51.6%的标本(32/62)中发现了溃疡周围边缘的血管炎。在组织病理学血管炎标本中,大多数标本可见局灶性血管炎(71.9%[32个中的23个]),而弥漫性血管炎的发生率为28.1%(32个中的9个)。溃疡周血管炎的敏感性很高(100%[95%置信区间,29%-100%])。此外,特异性较低(50.9%[95%置信区间,38.1%-63.6%])用于检测血管炎引起的溃疡。
结论:少数血管炎引起的溃疡。
结论:溃疡周围的局灶性血管炎是非特异性发现,在确定小腿溃疡的病因方面几乎没有诊断价值。重点应放在结合临床病史和检查,组织学,以及诊断溃疡时的实验室检查结果。
BACKGROUND: Histopathologic vasculitis is often reported in periulcer specimens, but the frequency and clinical significance of this finding have not been evaluated.
OBJECTIVE: We evaluated the sensitivity, specificity, negative predictive value, and positive predictive value of histopathologic vasculitis from the periulcer edge for detecting ulcers due to cutaneous vasculitis.
METHODS: We performed a retrospective chart review of patients with leg ulcers at a tertiary hospital between 2009 and 2016. Histopathologic slides were evaluated by 2 dermatopathologists who were blinded to the etiology of ulcer. Focal vasculitis was defined as involvement of fewer than 3 vessels.
RESULTS: Vasculitis at the periulcer edge was seen in 51.6% of the specimens (32 of 62). Of the specimens with histopathologic vasculitis, focal vasculitis was seen in the majority of specimens (71.9% [23 of 32]), whereas diffuse vasculitis was observed in 28.1% (9 of 32). Periulcer vasculitis yielded a high sensitivity (100% [95% confidence interval, 29%-100%]). Furthermore, the specificity was low (50.9% [95% confidence interval, 38.1%-63.6%]) for detecting vasculitis-induced ulcers.
CONCLUSIONS: Small number of vasculitis-induced ulcers.
CONCLUSIONS: Focal vasculitis from the periulcer edge is a nonspecific finding and provides little diagnostic value in determining the etiology of lower leg ulcers. Emphasis should be placed on the combination of clinical history and examination, histology, and laboratory findings when diagnosing ulcers.