136例慢性荨麻疹自体血清皮肤试验及实验室检测

目的：分析自体血清皮肤试验（ASST）及部分实验室检查指标与慢性荨麻疹（CSU）临床严重性？的相关性。方法：收集136 例CSU患者的临床资料,并进行ASST、血清总IgE、血浆D-二聚体、甲状腺功能及甲状腺抗体检测。结果：136例患者中总IgE升高37例,ASST阳性54例（39.7%）,其中ASST阳性患者病程45.27±65.67个月,明显长于ASST阴性患者的35.24±42.54个月（P＜0.01）。血浆D-二聚体升高49例（36%）,且与活动度评分（英文全称UAS）成正相关（P＜0.01, r=0.469）。患者抗甲状腺球蛋白抗体阳性24例(17.6%);甲状腺过氧化物酶抗体阳性14例(10.6%)。25例甲状腺功能异常患者中有9例ASST阳性。结论：ASST、血浆D-二聚体与CSU患者病情相关,而血清总IgE水平与病情无关。     

慢性自发性荨麻疹患者自体血清皮肤试验与白细胞介素-18的关系

 目的:了解慢性自发性荨麻疹（CSU）患者自体血清皮肤试验（ASST）与白细胞介素-18（IL-18）的关系,探讨慢性荨麻疹的发病机制。方法：对60例CSU患者（病例组）和30例健康者（对照组）分别进行ASST检查及采用ELISA法测定血清IL-18水平,并比较两组间的差别;同时比较病例组ASST阳性与阴性患者的血清IL-18水平。结果：病例组ASST阳性率为53.3%,对照组为3.3%,两组比较差异有统计学意义（X²=21.50,P<0.01）。病例组血清IL-18水平为(64.7±41.9) pg/mL,对照组为(44.9±15.7) pg/mL,两组比较差异有统计学意义（t=2.50,P<0.05）。病例组ASST阳性32例,血清IL-18水平为(72.4±47.6) pg/mL,ASST阴性28例,IL-18水平为(48.7±25.3) pg/mL,两者差异有统计学意义（t=3.27,P<0.05）。结论：慢性自发性荨麻疹患者ASST阳性率及血清IL-18水平均升高, IL-18可能参与了慢性自发性荨麻疹的免疫发病机制。     

慢性荨麻疹患者变应原检测及自体血清试验临床分析

目的:探讨慢性荨麻疹患者变应原检测和自体血清皮肤试验的临床意义。方法:皮肤点刺试验(SPT)检测30种变应原皮试液(包括吸入性和食物性),以生理盐水作阴性对照,以组胺作阳性对照,注射于前臂屈侧,20-30分钟后观察结果。自体血清试验(ASST)以自体血清注射于一侧前臂,另一侧注射生理盐水作阴性对照,30分钟后观察结果。结果:787例慢性荨麻疹患者中SPT有550例阳性(69.89%),6种以上变应原阳性332例(42.19%),吸入组阳性516例(65.57%)明显高于食物组309例(39.26%);ASST阳性为244例(31.00%),SPT阴性组ASST阳性率明显高于SPT阳性组。结论:SPT可以帮助我们寻找引起慢性荨麻疹的相关变应原。ASST阳性表明患者血清中存在自身抗体,可以作为自身免疫性荨麻疹的筛选试验。     

慢性荨麻疹患者自体血清皮肤试验与抗FcεRI抗体的关系分析

目的:了解慢性荨麻疹患者自体血清皮肤试验(ASST)与血清抗FcεRI抗体的关系.方法:对病例组56例慢性荨麻疹患者进行ASST,同时采用酶联免疫吸附试验法(ELISA)检测血清抗FcεRI抗体水平,并与对照组24名正常人比较.结果:病例组ASST阳性率为55 4%,血清抗FcεRI抗体水平为(2 89±2 36) U/L,两者均高于对照组(P<0 01);ASST阳性与阴性慢性荨麻疹患者血清抗FcεRI抗体水平分别为(3 23±2 62) U/L和(2 18±1 84) U/L,两者差异有统计学意义(P<0 05).结论:慢性荨麻疹患者ASST与抗FcεRI抗体水平有关,ASST阳性慢性荨麻疹患者血清抗FcεRI抗体水平较高.     

慢性自发性荨麻疹患者自体血清皮肤试验的免疫学机制及与临床特征和预后的关系

自体血清皮肤试验(ASST)在临床上常用于筛查慢性自发性荨麻疹(CSU)的免疫亚型, 但其免疫学机制、与CSU患者临床特征及预后的关系尚未明确。研究显示, ASST阳性与CSU患者免疫球蛋白G自身抗体升高、嗜酸性粒细胞和嗜碱性粒细胞计数减少、嗜碱性粒细胞CD63表达升高、循环炎症细胞因子水平变化相关, 与患者年龄、病程以及个人或家族史无关, 但可能是慢性荨麻疹病情严重程度的预测指标。ASST阳性患者可能对第二代H1抗组胺药反应不佳, 对奥马珠单抗起效缓慢, 但对环孢素和自体全血/血清注射治疗反应良好。该文综述ASST阳性患者的免疫学和临床特征, 探讨ASST阳性对不同治疗方案疗效的预测作用。     

慢性荨麻疹患者自体血清皮肤试验与抗FcεRI抗体的关系分析

目的:了解慢性荨麻疹患者自体血清皮肤试验(ASST)与血清抗FcεRI抗体的关系.方法:对病例组56例慢性荨麻疹患者进行ASST,同时采用酶联免疫吸附试验法(ELISA)检测血清抗FcεRI抗体水平,并与对照组24名正常人比较.结果:病例组ASST阳性率为55 4%,血清抗FcεRI抗体水平为(2 89±2 36) U...     

自体血清皮肤试验在慢性特发性荨麻疹中的应用研究

目的探讨自体血清皮肤试验(autologousserumskintest,ASST)在慢性特发性荨麻疹(chronicidiopathicurticaria,CIU)中的临床应用价值,分析ASST阳性的CIU患者的临床特点。方法采用ASST,对CIU患者组185例、健康对照组20名,过敏性疾病对照组50名患者(湿疹12例,异位性皮炎9例,面部皮炎6例,人工荨麻疹11例,支气管哮喘4例,过敏性鼻炎8例),进行测定,并记录临床症状评分及病史。结果185例CIU患者中ASST阳性率为35.68%(66/185),过敏疾病对照组及健康对照组全部阴性,3组间阳性率差异有显著性(P<0.05)。按ASST阳性结果将CIU组分为ASST阳性组与ASST阴性组。ASST阳性组的组胺风团直径较其他3组大(P<0.05),ASST阳性组在年龄分布、性别、病程等方面与ASST阴性组无统计学差异,ASST阳性的CIU患者皮疹的风团数量较多(P=0.001),风团持续时间较长(P=0.003),具有甲亢病史的患者(6.48%,12/185)出现ASST阳性结果的比例较高(58.3%,7/12)。结论在CIU患者血清是否存在自身抗体的初筛检查中,自体血清皮肤试验具有临床诊断价值及特异性,ASST阳性的慢性荨麻疹患者具有较严重的临床症状。     

154例慢性自发性 荨麻疹患者自体血清皮肤试验结果分析

目的探讨慢性自发性荨麻疹患者自体血清皮肤试验在临床中的应用价值。方法对154例慢性自发性荨麻疹患者及30名健康志愿者做自体血清皮肤试验,并对结果进行分析。结果 154例患者中67例(43.5%)患者检出阳性结果,对照组全部阴性;自体血清皮肤试验阳性与阴性的慢性自发性荨麻疹患者在性别、年龄分布及病程上差异无统计学意义(P0.05),自体血清皮肤试验阳性的慢性自发性荨麻疹患者症状评分及瘙痒持续时间明显高于阴性患者(P0.05),自体血清皮肤试验阳性程度与瘙痒持续时间呈正相关(P0.05)。自体血清皮肤试验阳性的慢性自发性荨麻疹患者伴发过敏史(药物、食物、吸入物)的比例高于阴性的患者(P0.05)。结论自体血清皮肤试验阳性的慢性自发性荨麻疹患者较阴性者病情重,该试验作为慢性荨麻疹功能性自身抗体的筛选试验可在临床上广泛应用。     

178例急性自发性荨麻疹转归为慢性的危险因素回顾性分析

目的：分析影响急性自发性荨麻疹（ASU）转归为慢性自发性荨麻疹（CSU）的危险因素。方法：回顾性分析本院2018年11月至2019年10月178例ASU患者的人口学信息、发病季节、初发病程、自诉可疑过敏原、自体血清皮肤试验（ASST）、7日荨麻疹活动度评分（UAS7）、血常规、血清总IgE测定、治疗药物,Logistic回归分析ASU转归为CSU的危险因素。结果：178例ASU中42例（23.60%）转归为CSU,单因素分析自诉食物过敏（P<0.001）、 ASST试验阳性（P<0.001）、初发病程（P＜0.001）与ASU患者转归为CSU具有相关性;多因素Logistics回归分析示自诉食物过敏（P=0.029）、ASST试验阳性（P=0.043）、初发病程长（P＜0.001）均是影响ASU转归为CSU的独立危险因素。结论：食物过敏、ASST试验阳性、初发病程长是ASU患者转归为CSU的危险因素。     

慢性荨麻疹患者粉尘螨变应原皮肤点刺反应与自体血清皮肤反应的关系

目的 探讨自体血清的自身反应和粉尘螨诱发的变态反应在慢性荨麻疹（CU）发病中的作用和相关性。方法 对831例CU患者同时进行自体血清皮肤试验（ASST）及粉尘螨皮肤点刺实验（SPT）,对ASST与粉尘螨变应原阳性之间的相关性进行分析。结果 831例CU患者ASST和粉尘螨的总阳性率分别为51.74%和64.62%,ASST阳性组和阴性组粉尘螨SPT阳性率分别为56.52%和73.86%,两组差异有统计学意义（P < 0.05）。ASST阳性组中ASST阳性程度和粉尘螨SPT阳性程度呈负相关性（P < 0.05）。结论 自体血清皮肤反应和粉尘螨变应原诱发的变态反应均在慢性荨麻疹的发病机制中呈负相关,对CU患者同时进行变应原和ASST检测有助于临床分型和治疗。     

The Relation of Autologous Serum Skin Test and Autologous Plasma Skin Test Result with Various Clinical and Laboratory Findings in Patients with Chronic Spontaneous Urticaria

BackgroundDespite the autologous serum skin test (ASST) and autologous plasma skin test (APST) is widely used test accessing whether a patient with chronic spontaneous urticaria (CSU) has autoreactivity or not, the clinician often encounter difficulty making correlation between the test result and clinical implications.ObjectiveThis study was aimed to find any clinical and laboratory findings related to the ASST and APST response. Agreement and correlation between the two tests was also analyzed.MethodsA retrospective study was conducted on 300 CSU patients who underwent ASST, APST. The subjects were divided into four groups according to the skin test result. Also, the degree of serum and plasma response was recorded.ResultsBoth ASST and APST positive group had shorter duration of the disease, higher incidence of at least one episode of angioedema than negative group. There were no significant differences in the positivity for autoantibodies including antinuclear, ds-DNA, and thyroid-related between the two groups. The predicted positive rate of ASST and APST according to age showed bimodal peak and decreasing pattern according to disease duration. Predicted positivity of both tests declined with increase in total immunoglobuline E (IgE) level. In the correlation study, the two tests showed high correlation coefficients.ConclusionASST and APST positivity may be related to disease duration and severity of CSU. The two tests showed a generally consistent result. Autoreactivity may be gradually lost as disease continues. We suggest the autoreactivity in CSU could arise independently from IgE mediated immune process.     

慢性特发性荨麻疹患者自体血清皮肤试验结果分析

目的：探讨慢性特发性荨麻疹(CIU)患者自体血清皮肤试验临床应用的意义。方法：对30例CIU患者及lO名正常对照者做自体血清皮肤试验，并对结果进行比较分析。结果：30例CIU患者自体血清皮肤试验阳性率为30％(9／30)，而对照组全部阴性。结论：部分CIU患者血清中有功能性的循环自身抗体存在，自体血清皮肤试验可作为CIU自身抗体的过筛试验。     

Autologous serum skin test response in chronic spontaneous urticaria and respiratory diseases and its relationship with serum interleukin-18 level

Autologous serum skin test (ASST) is mostly used in chronic spontaneous urticaria (CSU) to show autoreactivity. Interleukin-18 (IL-18) has also been shown to be involved in autoimmune conditions. To investigate the role of autoreactivity assessed by ASST in CSU and respiratory diseases and to investigate whether this autoreactive state is related to IL-18 level or other clinical covariates. Fifty-five patients with CSU (mean age: 40.3 ± 12.3 years), 70 patients with persistent asthma (mean age: 43.7 ± 9.6 years), 21 patients with seasonal allergic rhinitis (SAR) (mean age: 35.5 ± 11.8 years) and 20 normal controls (mean age: 37.7 ± 9.8) were included. All subjects underwent a laboratory examination and skin prick test. ASST was performed and serum IL-18 levels were measured in all subjects. Positive response to ASST and serum IL-18 levels were higher in CSU patients than those with respiratory diseases (asthma and SAR) (P = 0.034 and 0.002, respectively) and normal controls (P = 0.004 and 0.031, respectively). Considering all patients, IL-18 levels were higher in patients with positive ASST (301.8 ± 194.4 vs. 241.8 ± 206.3 pg/ml, P = 0.036) than ASST negative patients. ASST response was associated with disease severity in CSU (P = 0.037) and asthma patients (P = 0.001). Multivariate analysis showed that positive response to ASST was significantly associated with diagnosis of CSU (OR: 3.13, 95% CI: 1.25–7.87) and female gender (OR: 3.98, 95% CI: 1.19–13.38). ASST response could be related with activity of the disease. A positive ASST response found in respiratory diseases patients suggests that it may occur as a result of some inflammatory events during the diseases’ process.     

The autologous serum skin test: a screening test for autoantibodies in chronic idiopathic urticaria

One-third of patients with chronic idiopathic urticaria (CIU) have circulating functional autoantibodies against the high affinity IgE receptor FcepsilonRI, or IgE. The intradermal injection of autologous serum causes a weal and flare reaction in many patients with CIU, and this reaction forms the basis of the autologous serum skin test (ASST). We have determined the parameters of the ASST which define the optimal sensitivity and specificity for the identification of patients with autoantibodies. Two physicians (R.A. S. and C.E.H.G.) performed ASSTs in a total of 155 patients with CIU, 40 healthy control subjects, 15 patients with dermographism, nine with cholinergic urticaria and 10 with atopic eczema. Patients were classified as having functional autoantibodies by demonstrating in vitro serum-evoked histamine release from the basophils of two healthy donors. There were significant differences (P < 0.001) in the mean weal diameter, weal volume, weal redness and flare area of the intradermal serum-induced cutaneous responses at 30 min between patients with CIU with autoantibodies and either those without autoantibodies or control subjects. The optimum combined sensitivity and specificity of the ASST was obtained if a positive test was defined as a red serum-induced weal with a diameter of >/= 1.5 mm than the saline-induced response at 30 min. For R.A.S. and C.E.H.G., the ASST sensitivity was 65% and 71% and specificity was 81% and 78%, respectively. Using these criteria, the following subjects had positive ASSTs: none of 15 dermographics, none of 10 atopics, one of nine cholinergics and one of 40 controls.