HLA抗原与银屑病

自从1972年Russell①及White②等首先报导了HLA-B17与寻常型银屑病明显相关后,国外许多学者对寻常型银屑病、关节炎型银屑病及脓疱型银屑病与HLA抗原相关性进杆了研究.     

白芍总苷对老年中重度斑块状银屑病患者T淋巴细胞亚群及相关细胞因子的影响

目的 观察白芍总苷(TGP)治疗前后老年中重度斑块状银屑病患者 T 淋巴细胞亚群及相关细胞因子水平,探讨其可能的治疗机制。 方法 将符合要求的 63 例老年中重度斑块状银屑病患者随机分为 2 组,对照组给予外用药物治疗,试验组在外用药物的基础上给予白芍总苷胶囊口服,于治疗 8 周后观察 2 组患者 T 细胞亚群、血清白细胞介素-17(IL-17)、IL-23 及 IL-10 水平。 结果 2 组患者治疗后 CD4⁺、CD4⁺/CD8⁺及 IL-10 均增高,而 CD8⁺、IL-17 及 IL-23 均下降,组间比较试验组优于对照组,差异均有统计学意义(P<0.05),TGP 治疗前后银屑病皮损面积和严重程度指数(PASI)评分与 CD8⁺水平呈正相关,而与 CD4⁺、CD4⁺/CD8⁺及 IL-10 呈负相关性(P<0.05)。 结论 TGP 治疗老年中重度斑块状银屑病临床疗效显著,通过调节 T 淋巴...     

血热型/血燥型银屑病患者外周血T淋巴细胞亚群变化

目的 探讨血热型/血燥型银屑病患者外周血T淋巴细胞亚群变化规律,并和正常人作比较.方法 选择血热型银屑病患者35例、血燥型银屑病患者30例和正常人36例的外周血单一核细胞,采用流式细胞分析方法检测T淋巴细胞亚群中CD4⁺和CD8⁺的比例.结果 在银屑病患者外周血中,血热CD4M⁺淋巴细胞明显低于血燥型或正常人,CD8⁺淋巴细胞明显高于血燥型或正常人,CD4⁺/CD8⁺比值明显倒置,而血燥型CD4⁺和CD8⁺淋巴细胞与正常人相比没有差异.结论 T淋巴细胞变化可能是血热型/血燥型银屑病辨证求因的主要效应细胞之一.     

吉林地区汉族寻常性银屑病患者HLA-DRB1等位基因检测

据调查我国寻常性银屑病患病率约为0.123%^[1].其病因尚未完全清楚,银屑病与HLA相关性研究引起人们的关注^[2].由于HLA等位基因存在着种族与地域分布间的差异,以及寻常性银屑病具有遗传异质性的特点^[3],本研究采用聚合酶链反应/序列特异性引物(PCR/SSP)基因分型方法对80例寻常性银屑病患者DNA标本进行HLA-DRB₁位点基因多态性分析,旨在探讨吉林地区汉族寻常性银屑病与HLA-DRB₁等位基因的相关性.     

寻常性银屑病患者外周血淋巴细胞中红细胞趋化因子受体的表达

银屑病的发病机制尚不清楚,在银屑病患者体内存在着多种体液和细胞免疫紊乱^[1].研究表明调节活化和正常T细胞表达及分泌的趋化因子(RANTES)、单核细胞趋化蛋白-1(MCP-1)和白介素8(IL-8)等趋化因子在银屑病患者局部皮损表达明显增强,它们在银屑病的发病中起重要作用^[2].     

银屑病关节炎的临床特征和治疗

银屑病关节炎作为一种独立疾病的概念已被大家广泛接受,目前归为血清类风湿因子阴性脊柱关节病。此病并不罕见,可发生于7%-40%的银屑病患者中^[1]。关节炎严重影响患者的生活质量,早期诊断并及时治疗能延缓或阻止关节损害。为此,我们分析38例银屑病关节炎患者的临床、实验室及影象学特点。一、临床资料1.病例选择:全部病例为2000年1月至2003年12月本院门诊或住院患者,共38例。均详细询问病史,体检,检测血常规、血沉、C反应蛋白、类风湿因子(RF)、HLA-B27及X线检查。2.诊断标准:参考Moll和Wright的银屑病关节炎分类标准^[2]:①至少有1个关节炎并持续3个月以上,②至少有银屑病皮损     

CCL27和CCR10在寻常性银屑病皮损的表达及与PASI的相关性

目的 探讨皮肤特异性趋化因子CCL27及其受体CCR10在寻常性银屑病皮损中的表达和表达强度与疾病活动性的相关性.方法 SP免疫组化染色检测20例寻常性银屑病皮损区皮损和10例正常人皮肤中CCL27、CCR10的表达,以PASI评分评价银屑病患者疾病活动性.结果 ①CCL27在20例寻常性银屑病皮损和10例正常人皮肤中表达的阳性率分别为95%和20%,两者差异有统计学意义(X²=17.86,P<0.01);CCR10在20例寻常性银屑病皮损和10例正常人皮肤表达的阳性率分别为85%和10%,两者的差异有统计学意义(X²=15.63,P<0.01).②CCL27和CCR10在皮损中的表达水平与PASI评分均呈明显正相关,r值分别为0.82和0.83,P值均<0.01.结论 CCL27和CCR10的过度表达与银屑病患者的疾病活动性相关.     

通过调控滤泡性辅助性T细胞亚群研究蜈蚣败毒饮治疗银屑病模型鼠的机制

目的 观察蜈蚣败毒饮对银屑病鼠外周血滤泡辅助性T细胞(Tfh)表达量及对Tfh亚群Tfh1/Tfh2/Tfh17的影响,同时结合银屑病鼠皮损指数的变化量,分析Tfh及其亚群与皮损疗效之间的相关性。方法 将银屑病鼠随机分为空白组、模型组、甲氨蝶呤对照组、蜈蚣败毒饮低、中、高剂量组,共6组。经咪喹莫特造模及小鼠灌胃后,观察银屑病模型鼠的皮损指数,而后进行含药外周血单个核细胞(PBMC)制备,对各组样本采用流式细胞法以CD4⁺CXCR3⁺CCR6^-作为细胞表面标记检测Tfh1细胞的表达量,以CD4⁺CXCR3^-CCR6^-作为细胞表面标记检测Tfh2细胞的表达量,以CD4⁺CXCR3^-CCR6⁺作为细胞表面标记检测Tfh17细胞的表达量,得出了各组样本中Tfh细胞及各亚群Tfh1、Tfh2、Tfh17的数目和表达率,双变量回归分析法对Tfh及其亚群与皮损指数之间的相关性进行分析。结果 各药物组均能降...     

银屑病患者骨髓CD34+细胞体外定向分化的T细胞活性研究

目的 研究有家族发病倾向的银屑病患者骨髓CD34⁺细胞体外定向发育的T细胞活性.方法 免疫磁珠法分离家族史阳性银屑病患者及正常对照骨髓CD34⁺细胞,在骨髓基质细胞条件培养液构建的微环境下,在胸腺基质细胞的支持下,使其在体外向T细胞定向分化,免疫磁珠法收集CD3⁺T细胞,流式细胞仪检测CD4⁺CD8^-细胞及CD4^-CD8⁺细胞比例.分别采用MTT法及ELISA法检测自然增殖组及链球菌超抗原刺激后T细胞增殖活性及分泌细胞因子水平.结果 ①经骨髓CD34⁺细胞定向分化并扩增的CD3⁺T细胞中可检测到CD4⁺CD8^-、CD4^-CD8⁺T细胞,且银屑病患者组与正常对照组CD4⁺CD8^-及CD4^-CD8⁺T细胞比例无显著差异.②银屑病患者骨髓CD34⁺细胞定向分化的T细胞自然增殖组及链球菌超抗原刺激组增殖活性均显著高于正常人对照组.③银屑病患者T细胞自然增殖组培养上清白介素4、白介素8及干扰素γ与正常对照组差异无统计学意义,链球菌超抗原刺激后白介素4表达水平无显著改变,而白介素8及干扰素γ水平却显著高于正常人.结论 有家族发病倾向的银屑病患者外周血T细胞活性异常可能与骨髓造血细胞相关.     

角蛋白17反义寡核苷酸对银屑病SCID小鼠模型的作用

目的 建立重症联合免疫缺陷(SCID)小鼠银屑病动物模型,观察角蛋白17(K17)反义寡核苷酸(ASODN)对银屑病动物模型的作用.方法 将斑块状银屑病患者的皮损移植于SCID小鼠,构建银屑病SCID小鼠模型.然后分别以脂质体介导的K17 ASODN、正义寡核苷酸(SODN)及单纯乳剂基质作用于皮损,大体及H-E染色观察皮损改变,RT-PCR以及免疫组化检测K17的变化.结果 成功构建了SCID小鼠银屑病动物模型:与SODN组及单纯乳剂基质对照组相比,K17 ASODN治疗组皮损炎症恢复明显加快,组织学评分显著降低(P<0.01),K17 mRNA水平以及蛋白表达水平也均有不同程度降低.结论 K17 ASODN能够显著改善SCID鼠移植模型的银屑病病理改变,有望成为一种新的治疗措施.     

Antiperinuclear factors in psoriasis. Correlation with other serological abnormalities in 90 patients

Antiperinuclear factors (APF), studied in 90 patients suffering from psoriasis, were found in psoriasis without arthritis, in psoriasis with psoriatic arthritis and in psoriasis with true rheumatoid arthritis (RA): respectively 57, 36 and 43 p. 100. Patients with APF did not differ from patients without APF apart form rheumatoid factors detected by indirect immunofluorescence. They were much more frequent in psoriasis with APF. These results are compared with those of RA. They lead to look for other auto-antibodies in psoriasis.     

Leukocyte migration in vivo and in vitro in patients with psoriasis

Leukocyte migration in vivo was studied with a skin chamber technique in 21 patients with active psoriasis vulgaris and 18 with cleared psoriasis vulgaris. Measuring over 24 h, no difference was found between healthy volunteers and most patients with active psoriasis, although a subgroup of patients with long-lasting relapses showed subnormal migration values. In patients with cleared psoriasis on the other hand the in vivo leukocyte migration values were increased. In addition, leukocyte migration in vitro under agarose was studied, but no difference was found between healthy controls and patients with psoriasis, active or cleared.     

红皮病型银屑病伴发代谢相关性疾病的情况分析

目的分析红皮病型银屑病患者伴发代谢相关疾病(MD)的情况。方法对1995年1月-2010年3月在北京大学第三医院皮肤科住院的53例红皮病型银屑病患者伴发代谢相关疾病的临床资料进行回顾性分析,并与同期住院且年龄匹配的62例斑块状银屑病和60例急性荨麻疹患者(对照组)伴发代谢相关性疾病的情况作比较。结果红皮病型银屑病伴发MD、高脂血症(HLP)、腹型肥胖(AO)、代谢综合征(MS)及高尿酸血症(HUA)几率均显著高于对照组;斑块状银屑病伴发MD、高血压(HT)、HLP、AO、MS及HUA也显著高于对照组;男性红皮病型银屑病患者伴发HUA的几率高于对照组及斑块状银屑病组的男性患者,以上差异均有统计学意义(P均<0.05)。结论红皮病型银屑病与斑块状银屑病常伴发HLP、AO、MS及HUA等代谢相关疾病,男性红皮病型银屑病较男性斑块状银屑病更易伴发HUA。尿酸代谢紊乱是否与红皮病型银屑病发病相关还需要进一步研究。     

Hemoglobin A2 and F in patients with psoriasis.

HbA2 and HbF were studied in 91 patients with different forms of psoriasis: 29 with psoriasis vulgaris placata (restricted forms); 31 with psoriasis generalisata and erythroderma psoriaticum; 21 with psoriatic arthritis; 10 with psoriasis pustulosa. Statistically significant increase of HbA2 was established in patients with psoriasis vulgaris placata (restricted forms) as well in patients with psoriatic arthritis. HbF is statistically significant increased in all forms of psoriasis. The authors suggest, that there is probably in psoriasis a disturbance in the synthesis of the globine chains, which is genetically dependent.     

反相银屑病48例临床分析

目的　分析反相银屑病的临床特征。方法　收集 2 0 0 2年 9月～ 2 0 0 3年 8月一年间的银屑病病例 ,对其中的反相银屑病患者的病史、临床特征和治疗经过进行分析。结果　反相银屑病的临床表现主要为境界清楚的淡红至深红色斑片 ,有不同程度的浸润 ,鳞屑较少或无鳞屑 ;常累及腹股沟、腋窝、外生殖器、脐部等处 ;对以窄谱中波紫外线 (NB UVB)为主的综合治疗反应良好。结论　与一般的银屑病相比 ,反相银屑病在累及部位、临床表现和治疗反应等方面有其独有的特点 ,也有相同或近似之处。     

Deposits of Immunoglobulin and Complement in Psoriatic Lesions

Biopsy specimens from 43 patients with psoriasis were studied by immunofluorescence microscopy. Deposits of complement C3 and/or immunoglobulins were seen in the vessel walls and/or in the dermal-epidermal junction of all of 21 patients with pustular psoriasis, acute guttate psoriasis, psoriatic arthropathy and erythroderma. similar deposits were seen in nine out of 22 patients with psoriasis vulgaris. Deposits were found in clinically uninvolved skin in only one of 37 patients. The results might suggest that the deposition of immune complexes in the vessel walls are of importance for the development of psoriatic lesions.     

银屑病患者外周血干扰素γ和白介素18的表达

目的 探讨进行期银屑病患者外周血干扰素γ(IFN-γ)和白介素18(IL-18)的表达和相关性,及各型银屑病患者外周血IFN-γ的表达变化。方法 进行期寻常性银屑病20例,红皮病性银屑病19例,脓疱性银屑病10例,采用双抗体夹心酶联免疫吸附试验(ELISA)检测血浆中IFN-γ表达水平;对进行期寻常性银屑病患者,检测血浆中IL-18表达水平;检测葡萄球菌肠毒素(SEB)刺激下,进行期寻常性银屑病患者外周血单一核细胞(PBMC)上清液中IFN-γ和IL-18的表达水平。结果 进行期寻常性银屑病患者血浆IFN-γ水平为8.91±2.65,红皮病性银屑病为10.19±5.93,脓疱性银屑病为17.96±10.44,各型银屑病患者均高于正常人(5.70±2.82)。进行期寻常性银屑病患者血浆IL-18水平高于正常人。进行期寻常性银屑病患者PBMC在SEB刺激组IFN-γ和IL-18表达水平均高于空白对照组,且IFN-γ与IL-18表达水平呈显著正相关,r=0.55,P<0.05。结论 在银屑病的发病和进展中,检测IFN-γ的表达量,对早期判断银屑病病情进展、转归和治疗效果有指导意义。IL-18表达增高,推测IL-18可能也参与银屑病发病。     

Monocyte and neutrophil chemotaxis in psoriasis. Relation to the clinical status and the type of psoriasis

Chemotactic activity of purified monocytes and polymorphonuclear leukocytes was studied in fifty patients with psoriasis vulgaris and in forty-five healthy individuals by an objective in vitro assay with the use of a 51Cr-labeling technic. Both monocytes and polymorphonuclear leukocytes showed a statistically significant increase in chemotactic response, which was positively correlated with disease activity but not with the extent of the cutaneous lesions. The chemotactic activity of monocytes correlated with that of polymorphonuclear leukocytes in the same patients. Exacerbation of psoriasis was preceded by a rapid increase of polymorphonuclear leukocyte chemotaxis, and a decline of chemotaxis occurred during clinical improvement. The psoriatic leukocytes were 22% more sensitive than normal leukocytes to leukotriene B4 than to N-formyl-methionyl-leucyl-phenylalanine. Psoriatic plasma showed chemotaxis-enhancing properties, but only in patients with widespread cutaneous lesions. Additionally, monocyte and polymorphonuclear leukocyte chemotaxis was studied in twenty patients with pustular psoriasis and in fifteen patients with psoriatic arthritis. The chemotactic profiles in pustular psoriasis were different from those in psoriasis vulgaris. Patients with pustular psoriasis had significantly higher polymorphonuclear leukocyte chemotaxis than patients with psoriasis vulgaris, but the chemotactic activity of monocytes was normal. The presence of seronegative arthritis had no influence on chemotactic activity of psoriatic leukocytes.     

Psoriasis and drugs: influence of tetracyclines on the course of psoriasis

Patients with psoriasis vulgaris (462) were studied by questionnaire to find the effect on psoriasis of drug therapy for intercurrent diseases or focal infections. Of 462 patients with psoriasis, in 76 (16.45%) the disease became more severe during drug therapy. Of these, 19 worsened after administration of tetracyclines, and in five psoriasis was precipitated after therapy with drugs of the tetracycline family. We suggest that tetracyclines should be avoided in patients with psoriasis and in healthy persons with a genetic predisposition (positive family history, human leukocyte antigens B13, B17, B27).     

Evaluation of vaseline oil applied prior to UVB TL01 phototherapy in the treatment of psoriasis

BACKGROUND: Use of emollient prior to phototherapy could enhance UV transmission through psoriasis plaques on the condition that the emollient is not photoprotective. Emollient pretreatment with narrow-band phototherapy (313 nm) has not been studied extensively. We conducted a study to assess if vaseline oil prior to UVB TL01, in chronic psoriasis plaques could accelerate psoriasis clearance. METHODS: Fifteen patients with chronic psoriasis plaques were enrolled in a prospective, single-blind, controlled study. For each patient, one to three symmetrical pairs of plaque were selected and scored initially and after every six exposures. RESULTS: On the vaseline oil pretreated side, significantly more plaques were cleared, especially in severe psoriasis. Scaling and infiltration were significantly improved. Application of vaseline oil was more interesting in thick and scaly psoriasis probably because the oil penetrates the intercellular space allowing an optical matching effect which increases the UV transmission. CONCLUSION: We strongly recommend vaseline oil pretreatment with UVB TL01 phototherapy in psoriasis, especially in severe psoriasis.