糖尿病胫前色素斑的病理改变揭示血管-免疫异常

doi:10.12122/j.issn.1673-4254.2026.01.07

摘要/Abstract

摘要：

目的探究糖尿病胫前色素斑患者病理特征及免疫细胞浸润特点。方法收集在天津医科大学朱宪彝纪念医院行大腿截肢术的糖尿病患者42例，术前由医生查看患者胫前皮肤并诊断，有糖尿病胫前色素斑患者纳入糖尿病胫前色素斑组，无糖尿病胫前色素斑患者纳入无糖尿病胫前色素斑组。应用HE染色和Masson染色观察两组患者组织病理表现差异。测量计算表皮层厚度和真皮层血管密度，使用蛋白免疫印迹法检测组织VEGFA和VEGFR2表达。应用免疫组织化学染色法检测CD4、CD8阳性细胞表达情况，计算CD4/CD8比值，探讨糖尿病胫前色素斑患者病理特征及免疫细胞浸润特点。结果糖尿病胫前色素斑组在HE染色下可见表皮棘层增厚，表皮突不规则向下延伸，角化过度，基底层黑色素沉积，真皮层毛细血管增多，血管周围可见局限性界限清楚的炎症细胞浸润。无糖尿病胫前色素斑组在HE染色下表皮厚度正常，表皮突较平，基底层未见明显黑色素沉积，真皮层无明显炎症细胞浸润。Masson染色下，糖尿病胫前色素斑组胶原纤维排列欠规则，部分胶原纤维增粗，呈透明样变。无糖尿病胫前色素斑组Masson染色下胶原纤维排列规则，纤维清晰。与无糖尿病胫前色素斑组比较，胫前色素斑组表皮层厚度和真皮层血管密度明显增加（P<0.05）。与无糖尿病胫前色素斑组比较，胫前色素斑组的CD4阳性表达量及CD4/CD8比值明显升高，CD8阳性表达量明显降低（P<0.05）。结论糖尿病胫前色素斑患者与无糖尿病胫前色素斑患者组织病理学有明显的差异，糖尿病胫前色素斑的病因可能与血管-免疫异常有关。

关键词: 糖尿病胫前色素斑, 糖尿病皮肤病, 糖尿病并发症, 血管-免疫异常

Abstract:

Objective To explore pathological and immune cell infiltration characteristics of pigmented pretibial patches in diabetic patients. Methods Forty-two diabetic patients undergoing thigh amputation at Tianjin Medical University Chu Hsien-I Memorial Hospital were enrolled. Before the operation, the pretibial skin of the patients were examined and sampled for HE and Masson staining. The thickness of the epidermis and the density of blood vessels in the dermis were compared between patients with and without pigmented pretibial patches. The expressions of VEGFA and VEGFR2 in the skin tissues were detected using Western blotting, and CD4⁺ and CD8⁺ cells and the CD4/CD8 ratio were analyzed with immunohistochemical staining. Results Compared with the patients without pigmented pretibial patches, the patients with pigmented pretibial patches showed obvious thickening of the epidermal spinous layer, irregular downward extension of the epidermal projections, hyperkeratosis, melanin deposition in the basal layer, increased capillaries in the dermis, and localized, well-defined inflammatory cell infiltration around the blood vessels. In pigmented pretibial patches group, Masson staining revealed irregular arrangement, thickening and hyaline degeneration of collagen fibers, significantly increased epidermal thickness and blood vessel density in the dermis, increased CD4⁺ cells and the CD4/CD8 ratio, and reduced CD8⁺ cells. Conclusion The pigmented pretibial patches in diabetic patients show obvious pathological changes possibly due to vascular and immune abnormalities.

Key words: pigmented pretibial patches, diabetic dermopathy, diabetic complications, vascular-immune abnormalities

刘信邦, 常柏. 糖尿病胫前色素斑的病理改变揭示血管-免疫异常[J]. 南方医科大学学报, 2026, 46(1): 66-73.

Xinbang LIU, Bai CHANG. Pathological characteristics of pigmented pretibial patches and vascular-immune abnormalities in diabetic patients[J]. Journal of Southern Medical University, 2026, 46(1): 66-73.

图/表 6

图1 HE和Masson染色

Fig.1 HE and Masson staining of skin tissues from diabetic patients with and without pigmented pretibial patches (PPP). A, B: HE staining in PPP group. C, D: HE staining in non-PPP group. E, F: Masson staining in PPP group. G, H: Masson staining in non-PPP group. Original magnification: ×10 in A, C, E, G; magnification: ×40 in B,D, F, H. ▲: Melanin deposition sites; ●: Areas of capillary proliferation; ■: Regions of inflammatory cell infiltration; ★ : Locations of collagen fibers with hyaline degeneration. (A, C, E, G: Scale bar=200 μm; B, D, F, H: Scale bar=400 μm).

表1 两组组织病理学表现比较

Tab.1 Comparison of histopathological characteristics between the two groups

Characteristics	PPP group (n=17)	non-PPP group (n=25)	P
Epidermis layer thickness (μm)	114.59±27.52	98.24±19.57	<0.05
Dermal MVD (no./mm²)	19.17±8.08	12.73±6.87	<0.01
CD4	1.72±0.79	1.04±0.66	<0.01
CD8	0.53±0.18	0.74±0.36	<0.05
CD4/CD8 ratio	2.69 (2.24, 3.71)	1.54(1.23, 1.73)	<0.01

图2 免疫组织化学染色检测CD34表达

Fig.2 Immunohistochemical staining for detecting CD34 expression in the skin tissue from PPP (A) and non-PPP (B) groups (×100). Black arrows indicate the areas with microvessel proliferation.

图3 免疫组化染色检测CD4、CD8表达

Fig.3 Immunohistochemical staining for CD4 and CD8 for comparison of T-cell profiles between the two groups. A,B: Immunohistochemical staining for CD4 in PPP group. C, D: Immunohistochemical staining for CD8 in PPP group. E,F: Immunohistochemical staining for CD4 in non-PPP group. G,H: Immunohistochemical staining for CD8 in non-PPP group; magnification ×40 (A, C, E, G); magnification ×100 for (B, D, F, H).

图4 PPP组与无PPP组表皮层厚度、真皮层微血管密度、CD4 T淋巴细胞和CD8 T淋巴细胞表达情况比较

Fig.4 Comparison of epidermal thickness, dermal microvascular density and expression levels of CD4 and CD8 between PPP group and non-PPP group (n=42). *P<0.05, **P<0.01 vs non-PPP group.

图5 蛋白免疫印迹实验结果

Fig.5 Western blotting showing elevated protein expression levels of VEGFA and VEGFR2 in PPP group versus non-PPP group (n=6). **P<0.01 vs non-PPP group.

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