Tìm hiểu về cơ chế bệnh sinh, sự biến đổi tế bào gai giúp phân biệt các bệnh da có bọng nước, mụn nước

Bệnh da có bọng nước, mụn nước là một tình trạng bệnh lý thường gặp trong các bệnh lý về da do nhiều nguyên nhân với các cơ chế sinh bệnh khác nhau và triệu chứng lâm sàng phong phú. Cùng với việc thăm khám lâm sàng, chúng ta cần hiểu rõ về cơ chế bệnh sinh, tiêu chuẩn chẩn đoán cận lâm sàng để  chẩn đoán chính xác tránh nhầm lẫn.

Tìm hiểu về cơ chế bệnh sinh, sự biến đổi tế bào gai giúp phân biệt các bệnh da có bọng nước, mụn nước

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      Bệnh da có bọng nước, mụn nước là một tình trạng bệnh lý thường gặp trong các bệnh lý về da do nhiều nguyên nhân với các cơ chế sinh bệnh khác nhau và triệu chứng lâm sàng phong phú. Cùng với việc thăm khám lâm sàng, chúng ta cần hiểu rõ về cơ chế bệnh sinh, tiêu chuẩn chẩn đoán cận lâm sàng để  chẩn đoán chính xác tránh nhầm lẫn.

Phân loại các bệnh da có bọng nước, mụn nước theo nguyên nhân như sau:

+ Bệnh da có bọng nước do cơ chế miễn dịch: (Pemphigus, Pemphigoid, Duhring –Brocq).

+ Bệnh da có bọng nước do virus: (Herpes Simplex, Zona, Thủy đậu.

+ Bệnh da có mụn nước, bọng nước do nhiễm khuẩn: Chốc.

+ Các vết trợt niêm mạc miệng, sinh dục.

I. Bệnh da có bọng nước do cơ chế miễn dịch (Pemphigus, Pemphigoid,  Duhring –Brocq)

 1. Pemphigus:

– Cơ chế bệnh sinh:

Thông thường hệ thống miễn dịch của cơ thể tạo ra các kháng thể tấn công những virus và vi khuẩn có hại  nhằm giữ cho cơ thể khoẻ mạnh. Trong bệnh pemphigus hệ thống miễn dịch nhận định nhầm các tế bào ở da và niêm mạc là những vật chất lạ, và tấn công chúng, vị trí tấn công là các cầu nối desmosome đây là cầu nối giữa những tế bào gai ở lớp thượng bì mà bình thường có nhiệm vụ giữ cho da được nguyên vẹn.

Pemphigus: là bệnh da có mụn nước, bọng nước mạn tính do tế bào gai mất liên kết gây nên hiện tượng ly gai, khi những tự kháng thể tấn công các cầu nối desmosome giữa các tế bào gai, các tế bào gai bị chia tách, dịch gian bào tập trung tại vị trí tổn thương hình thành bọng nước. Điều này gây nên thương tổn giống như bị bỏng hay vết rộp không lành lại. Ở một số trường hợp, những vết rộp đó có thể chiếm một vùng rộng trên cơ thể.

–  Lâm sàng: Bọng nước nhăn nheo, dễ vỡ, không tự lành nếu không được điều trị, các tế bào da và niêm mạc đều bị tấn công.

Vị trí bọng nước thường có ở cả da và niêm mạc, toàn trạng bệnh nhân suy sụp.

– Hình ảnh cận lâm sàng: Tế bào gai bị chia tách có nhân lớn, chiếm 2/3 tế bào, có khoảng sáng quanh nhân được gọi là tế bào gai lệch hình ( + ).

2. Pemphigoid:

–  Cơ chế bệnh sinh:

Là kết quả của quá trình kết hợp giữa tự kháng thể với kháng nguyên trên bề mặt của tế bào sừng có sự tham gia của bổ thể, bạch cầu đa nhân trung tính, bạch cầu ái toan. Bọng nước ở dươí thượng bì, được hình thành dưới tác dụng của các chất trung gian hoá học, được giải phóng từ dưỡng bào và các bạch cầu ái toan.

– Lâm sàng: Bọng nước căng, to có khi bằng quả táo, toàn trạng BN bình thường.

– Hình ảnh cận lâm sàng:

+ Có nhiều tế bào bạch cầu đa nhân ái toan.

+ Không có tế bào gai lệch hình.

3. Duhring Brocq:

– Lâm sàng: Là một bệnh miễn dịch dị ứng có tính chất mãn tính, hay tái phát, với đa dạng tổn thương như mụn nước tập trung thành từng cụm, dát đỏ, sẩn phù, thương tổn tập trung thành cụm có tính chất đối xứng, kèm theo ngứa. Toàn trạng bệnh nhân bình thường.

– Hình ảnh cận lâm sàng:

+ có tế bào bạch cầu đa nhân Trung tính và tế bào bạch cầu Ái toan.

+ Không có tế bào gai lệch hình.

 II. Bệnh da có mụn nước do virus (Herpess simplex, Zona, Thuỷ đậu)

– Cơ chế bệnh sinh: Trong các bệnh da có bọng nước do virus thì virus đã gây phá vỡ màng của lớp tế bào biểu mô dẫn đến nhân của các tế bào tụ lại tạo thành tế bào to được gọi là tế bào đa nhân khổng lồ.

– Xét nghiệm:

+ Có tế bào đa nhân khổng lồ.

+ Có thể có tế bào gai lệch hình do ngoại độc tố của vi khuẩn tác động lên các cầu nối của tế bào gai.

III. Các bệnh da có bọng nước do vi khuẩn (Chốc).

– Cơ chế bệnh sinh: Nguyên nhân do ngoại độc tố của vi khuẩn tác động lên các cầu nối của tế bào gai.

–  Hình ảnh cận lâm sàng:

+ Có nhiều bạch cầu đa nhân trung tính

+ Có thể có tế bào gai lệch hình.

 

Ths.BS. Cao Thị Kim Chúc – TK Xét nghiệm


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