氯雷他定联合阿伐斯汀治疗慢性难治性荨麻疹的效果及安全性分析

目的 探讨氯雷他定联合阿伐斯汀治疗慢性难治性荨麻疹的效果及安全性。方法 选择2019年1月至2020年6月本院接收的慢性难治性荨麻疹患者85例,采用随机数字表法将其分为对照组(42例)和观察组(43例)。对照组采用阿伐斯汀胶囊口服治疗,在对照组基础上,观察组采用氯雷他定片口服治疗,治疗4周后,比较两组临床疗效、实验室相关指标[白细胞(WBC)、5-羟色胺(5-HT)、血清免疫球蛋白(IgE)]、安全性。结果 观察组临床总有效率(95.35%)高于对照组(78.57%),差异有统计学意义(χ2=5.308,P=0.021);治疗4周后,观察组5-HT水平(127.65±8.61)μg/L高于对照组的(104.52±9.32)μg/L,IgE水平(57.41±7.53)IU/mL、WBC水平(9.20±1.95)g/L低于对照组的(72.26±8.40)IU/mL、(11.31±2.04)g/L,差异有统计学意义(t=11.889、8.587、4.875,P均=0.000);观察组不良反应发生率(11.63%)与对照组(7.14%)对比,差异无统计学意义(χ2=0.501,P=0.713)。结论 予以慢性难治性荨麻疹患者氯雷他定联合阿伐斯汀治疗效果确切,可改善患者实验室相关指标,且未明显增加不良反应,安全性较高。     

Comment on “The effect of omalizumab on hematological and inflammatory parameters in patients with chronic spontaneous urticarial”: reply from authors

Abstract

We read Cosansu’s commentary entitled “Effectiveness of the new inflammatory parameters in patients with chronic spontaneous urticarial” to our study with great interest. The author remarked that a limited number of patients had C-reactive protein levels and it was not specified whether there were any other drugs used by the patients and no information was given about the severity of the disease in our study.     

Co-occurrence of IgE and IgG autoantibodies in patients with chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) pathogenesis shows a complex and still unclear interplay between immunoglobulin (Ig)G- and IgE-mediated autoimmunity, leading to mast cell and basophil degranulation and wheal formation. The objective of this study was to evaluate at the same time IgE- and IgG-reactivity to well recognized and recently reported autoantigens in CSU patients, and to assess the effects of such reactivity on response to the anti-IgE monoclonal antibody omalizumab. Twenty CSU patients underwent omalizumab treatment. Urticaria activity score 7 (UAS7) was recorded at baseline and at different drug administration time-points for categorizing early-, late- or non-responders. At baseline, sera from the 20 patients and from 20 controls were tested for IgE and IgG autoantibodies to high- and low-affinity IgE receptors (FcεRI and FcεRII), tissue factor (TF) and thyroglobulin (TG) by immunoenzymatic methods. Antibody levels were compared with those of controls and analysed according to response. Eighteen patients were omalizumab responders (11 early and seven late), while two were non-responders. More than 50% of patients had contemporary IgE and IgG to at least to one of the four different autoantigens. Late responders showed higher levels of both anti-TF IgE and IgG than early responders (P = 0·011 and P = 0·035, respectively). Twenty-five per cent of patients had levels of anti-FcεRI IgE, exceeding the upper normal limit, suggesting that it could be a novel auto-allergen in CSU. In CSU, there is an autoimmune milieu characterized by the co-existence of IgE and IgG autoantibodies to the same antigen/allergen, particularly in late responders to omalizumab, possibly explaining the slower response.     

Transient improvement of urticaria induces poor adherence as assessed by Morisky Medication Adherence Scale‐8

Poor adherence to medication is a major public health challenge. Here, we aimed to determine the adherence to oral and topical medications and to analyze underlying associated factors using the translated Japanese version of Morisky Medication Adherence Scale‐8 regarding urticaria treatment. Web‐based questionnaires were performed for 3096 registered dermatological patients, along with a subanalysis of 751 registered urticaria patients in this study. The adherence to oral medication was significantly associated with the frequency of hospital visits. Variables that affected the adherence to topical medication included age and experience of drug effectiveness. The rate of responses that “It felt like the symptoms had improved” varied significantly among the dermatological diseases treated with oral medications. Dermatologists should be aware that adherence to the treatment of urticaria is quite low. Regular visits and active education for patients with urticaria are mandatory in order to achieve a good therapeutic outcome by increasing the adherence.     

补充维生素D3协同第二代抗组胺药物治疗慢性自发性荨麻疹的临床疗效观察和作用机制研究

目的：评价补充维生素D3（VD3）协同第二代抗组胺药物对控制慢性自发性荨麻疹（CSU）临床症状的疗效。方法：① 90例CSU患者，21例慢性可诱导性荨麻疹(CIndUI)和55例健康自愿者选自武汉大学人民医院皮肤科门诊（2017年10月至2018年10月）；② 受试者进行血清25羟维生素D3［25-(OH)D3］，血浆D-二聚体(D-dimer)、纤维蛋白降解产物（FDP），血沉（ESR）等实验室检查，并给予荨麻疹活动度评分（UAS7）；③ 分离和体外培养正常人与CSU患者各15例外周血单个核细胞（PBMC），经1 nM和10 nM 1α,25-(OH)2D3处理后用实时荧光定量PCR技术检测白介素-6(IL-6)和维生素D受体（VDR）mRNA的表达水平；④ VD3严重缺乏（血清浓度<10 ng/mL）的患者补充大剂量(2400 IU/d)VD3，缺乏者(10~20 ng/mL)给予补充小剂量（800 IU/d）VD3，设未补充患者作对照，于6周和12周时再行UAS7评分。结果：与健康对照组相比，CSU患者血清25-(OH)D3水平明显减少，D-dimer、FDP及ESR水平明显增加，且与UAS7评分呈正相关；qPCR结果显示15例CSU患者PBMC IL-6和VDR mRNA表达水平较正常人明显增加；经1α,25-(OH)2D3处理后，IL-6 mRNA表达减少，VDR mRNA表达增加(P<0.05)；与未补充组比较，VD3严重缺乏组给予补充大剂量VD3 12周，UAS7评分明显下降(P<0.0001)。结论：补充VD3有助于协同控制CSU的临床症状，可能与其抑制了荨麻疹亚临床炎症有关。     

慢性自发性荨麻疹患者血清特异性IgE抗体与自体血清皮肤试验的关系

目的：比较慢性自发性荨麻疹(CSU)患者血清特异性IgE抗体检测结果与自体血清皮肤试验(ASST)的关系，探讨ASST的临床意义。方法：对305例慢性自发性荨麻疹患者同时进行血清特异性IgE抗体检测及自体血清皮肤试验(ASST)，对两组的阳性率进行统计分析。结果：305例CSU患者螨虫组合(屋尘螨/粉尘螨)血清特异性IgE抗体与ASST总阳性率分别为47.87%和58.03%，ASST阳性组和阴性组中螨虫组合血清特异性IgE抗体阳性率分别为34.46%和66.41%，两组差异有统计学意义(P<0.05)。ASST阳性程度与对应螨虫、屋尘、狗、大豆、虾血清特异性IgE抗体检测水平呈负相关性(P<0.05)。结论：CSU患者部分常见变应原血清特异性IgE抗体与自体血清皮肤试验结果呈负相关，建议将ASST纳入常规CSU临床检测，ASST阳性的患者可以不进行血清特异性IgE抗体检测。     

Factors associated with relapses among patients treated for acute urticaria

The benefit of corticosteroids in acute urticaria is controversial. Our objective was to determine the factors associated with relapses in patients presenting with acute urticaria. A retrospective observational study, including all patients with acute urticaria who visited the angioedema reference center of Academic Public Hospitals – Saint‐Antoine in Paris between January 2015 and June 2017, was conducted. The study inclusion criterion was a diagnosis of acute urticaria in an adult patient. The urticaria was spontaneous or inducible urticaria. The primary outcome was relapse at day 7 and the secondary outcome was relapse at week 6. A total of 184 patients with a first episode of acute urticaria were included. Most of the patients were female (66%) with a mean age of 42 ± 16 years. Corticosteroid administration for treatment of acute urticaria was used in 102 (55%) patients. Overall, 85 (46%) patients had relapses after less than 7 days whereas 168 (91%) patients had relapses after more than 6 weeks. In univariate analysis, the rate of corticosteroid administration was significantly higher in cases of relapse after less than 7 days. No difference in relapse rates after more than 6 weeks appeared. In the multivariate analysis, the independent factor associated with relapses after less than 7 days was the administration of corticosteroids as treatment of acute urticaria (odds ratio, 1.93; 95% confidence interval, 1.06–3.57; P = 0.03). The prevalence of corticosteroid administration for patients with acute urticaria was high. Corticosteroid administration was an independent risk factor associated with relapses after less than 7 days.     

桂枝汤加减治疗营卫不和型慢性瘾疹的临床疗效

目的:观察桂枝汤加减治疗营卫不和型慢性瘾疹的临床疗效。方法:将我院门诊2017年10月-2019年10月收治的48例营卫不和型慢性瘾疹患者,按随机数表法分成对照组(24例)与实验组(24例)。对照组实施常规西药治疗,实验组实施桂枝汤合地骨皮、白鲜皮加减治疗。对照两组治疗前后症状积分、临床疗效及并发症发生率。结果:两组治疗前症状积分相比无显著差异(P>0.05)。治疗后,两组症状积分均有所下降,实验组低于对照组;实验组临床总有效率为91.67%(22/24)高于对照组的66.67%(16/24);实验组并发症发生率0(0/24)低于对照组的16.67%(4/24),差异具有统计学意义(P<0.05)。结论:在营卫不和型慢性瘾疹治疗中,采取桂枝汤加减治疗,可明显降低症状积分,提高临床治疗效果,减少并发症,效果理想。