IL-17／IL-23炎症轴在慢性自发性荨麻疹中的表达及临床意义

目的：研究IL-17／IL-23炎症轴在慢性自发性荨麻疹（ CSU ）中的表达及临床意义。方法：用ELISA法检测并比较158例慢性自发性荨麻疹患者和121例健康者血清中IL-17、IL-23的表达水平;同时用自体血清皮肤实验（ASST）将CSU患者分成ASST（＋）和ASST（－）两组,检测并比较两组血清中IL-17、IL-23的表达水平。结果：CSU患者血清IL-17、IL-23水平较正常对照组表达明显升高（ t值分别为13.02、3.87,P值均＜0.01）,ASST（＋）的CSU患者血清中IL-17、IL-23水平较ASST（－）的CSU患者表达升高（t值分别为8.36、4.96,P值均＜0.01）。结论：IL-17／IL-23炎症轴在CSU的发病中起着重要作用,并可影响患者的自身免疫水平。     

慢性自发性荨麻疹免疫相关指标与病情的相关性分析

目的：探讨慢性自发性荨麻疹（ CSU）患者免疫相关指标：ASST、总IgE、免疫五项及甲状腺自身抗体与CSU病情的相关性。方法：收集79例确诊为CSU患者的血清标本,检测ASST、IgE、C3、C4、IgA、IgM、IgG及甲状腺自身抗体（ TPOAB、TGAB）水平,采用UAS7法评估患者病情,分析各指标与病情的相关性,并与正常对照组30例比较。结果：79例患者中ASST阳性率为54％,ASST、血清总IgE、C3、C4、IgA、IgM、IgG、TPOAB及TGAB水平与UAS7评分均无相关性（ P值均＞0.05）。病情为轻度的患者血清C3水平明显低于中度,差异有统计学意义（P＜0.05）。与正常对照组比较,CSU患者各指标中仅总IgE水平高于正常对照组,差异存在统计学意义（ P＜0.05）。结论：补体C3水平可为评估CSU患者病情提供一定的参考价值。     

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。     

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。     

慢性自发性荨麻疹血小板参数及P选择素的检测

目的： 检测慢性荨麻疹（CSU）患者血小板参数及P选择素的表达水平,并分析与疾病严重程度的相关性。方法：对120例CSU患者和40例健康对照者进行血小板相关参数和可溶性P选择素检测,并分析与自身免疫血清实验（ASST）结果、CSU疾病严重度评分（USS）的相关性。 结果： CSU组平均血小板体积（MPV）、血小板分布宽度(PDW) 和可溶性P选择素水平分别为11.23±1.36fl、13.41±2.26fl和74.16±20.32 ng/mL,明显高于正常对照组的9.38±1.24fl,11.17±2.51fl和32.14±8.37ng/mL。CSU组血小板计数为(176.16±41.05)×109/L,明显低于健康对照组的(227.35±42.33)×109/L。所有患者中USS评分与P选择素呈正相关,ASST阳性患者中USS与MPV呈正相关。结论： CSU组MPV、PDW和可溶性P选择素值升高,且与疾病严重程度相关,提示CSU患者中存在血小板活化。     

中文版荨麻疹控制评分量表及信效度验证

【摘要】 目的 翻译荨麻疹控制评分（UCT）,并检验该量表的信效度、敏感性以及筛选准确性。方法 经过翻译、回译和文化调试,确定荨麻疹控制评分量表的条目。应用该量表调查51例慢性自发性荨麻疹（CSU）、41例慢性诱导性荨麻疹（CIndU）患者和11例CSU合并CIndU患者。入组后8周内,81例使用抗组胺药治疗,8例使用奥马珠单抗治疗,14例抗组胺药联合奥马珠单抗治疗。入组时和入组后第4、8周时,用皮肤病学生活质量指数（DLQI）、荨麻疹活动评分（UAS）评估生活质量损害和疾病活动情况。采用Cronbach′s α系数评估问卷内部一致性信度。通过与DLQI、UAS28评分比较,检验中文版UCT的聚合效度、已知族群效度、敏感性及筛选准确性。结果 中文版UCT包含4个条目,回顾性评价过去4周内疾病的临床症状和体征、对生活质量的影响、治疗效果和总体疾病控制情况。CSU组UCT量表各条目得分的Cronbach′s α系数为0.886 ~ 0.945,CIndU组为0.834 ~ 0.958。入组时,CSU组与CIndU组UCT与DLQI评分显著负相关（rs值分别为-0.672,-0.578,均P＜0.01）。第4周和8周时,CSU组UCT与UAS28、DLQI评分均呈显著负相关（4周：rs值分别为-0.654、-0.829,均P＜0.01;8周：rs值分别为-0.717、-0.765,均P＜0.01）,CIndU组UCT与DLQI评分亦显著负相关（rs值分别为-0.834、-0.778,均P＜0.01）。CSU组第4周与第8周之间UCT变化量与UAS变化量显著相关（rs = -0.569,P＜0.01）;与入组时比较,第4、8周时 UCT变化量与相应DLQI评分变化量显著相关（rs值分别为-0.693、-0.447,均P＜0.01）。对于CIndU组,与入组时比较,第4周与第8周时UCT变化量与DLQI变化量亦显著相关（rs值分别为-0.615、-0.408,均P＜0.01）。不同UAS、DLQI评分组间UCT评分差异均有统计学意义（均P＜0.05）。 结论 中文版UCT是有效、可靠的CSU和CIndU患者的临床管理工具,可用于评估疾病控制情况,在一定程度上反映疾病活动度及疾病相关生活质量。     

奥马珠单抗对慢性自发性荨麻疹患者的临床疗效和安全性分析

目的:观察奥马珠单抗治疗慢性自发性荨麻疹（CSU）的临床疗效和安全性。方法:回顾性分析2020年3-9月在中国医学科学院皮肤病医院诊断为CSU并接受奥马珠单抗（300 mg/4周,皮下注射）治疗3次的60例患者的临床资料。分别在第0、2、4、6、8、10、12周使用7 d荨麻疹活动评分（UAS7）和慢性荨麻疹生活质量评...     

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。     

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.     

Serum neopterin levels in spontaneous urticaria and atopic dermatitis

Serum neopterin may be considered a diagnostic marker of the degree of activation of the immune system. This preliminary study was performed to measure serum neopterin levels in patients with acute spontaneous urticaria (ASU), chronic spontaneous urticaria (CSU) and atopic dermatitis (AD). In total, 180 patients [96 men, 84 women; mean age 23.1 years; 41 with spontaneous urticaria (13 ASU and 28 CSU), 48 with AD] and 96 healthy controls were enrolled in the study. Patients with ASU had the highest neopterin levels, and all three groups of patients (ASU, CSU and AD) had higher values than normal subjects. This preliminary study demonstrates that serum neopterin could be a biomarker of immune activation in patients with SU or AD.     

Factors linked to disease severity and time to remission in patients with chronic spontaneous urticaria

Biomarkers useful for the evaluation and management of patients with chronic spontaneous urticaria (CSU) are not currently available. A review of various clinical and laboratory markers that have been studied to assess their value for determining the severity or predicting the evolution of disease in adult patients with CSU was carried out. A search of the medical literature on PubMed and MEDLINE including the terms urticaria, chronic urticaria, chronic idiopathic urticaria, CSU, severity, prognosis and treatment was performed. Based on our review of the literature, among the clinical markers studied, higher age at onset, being female, long disease duration and aspirin/NSAID hypersensitivity may be linked to both severe CSU and a long time to spontaneous remission. In addition, a positive autologous serum skin test (ASST) may be associated with severe CSU, and comorbidity of inducible urticaria and concomitant recurrent angio‐oedema may be linked to longer CSU duration. Potential biomarkers of CSU severity and/or duration include basophil numbers and susceptibility to activation, inflammatory markers, markers of activation of the extrinsic coagulation pathway, immunoglobulin E and vitamin D. Although the described markers are promising, further studies on representative and well‐characterized patient populations are needed to determine the value of these clinical and biological markers for predicting the severity and course of disease in patients with CSU.     

慢性自发性荨麻疹患者外周血嗜碱粒细胞CD63和CD203c的表达

目的：检测慢性自发性荨麻疹患者中外周血嗜碱粒细胞的活化状态。方法：采用流式细胞技术分别检测慢性自发性荨麻疹患者风团不同持续时间下（A组<2 h,15例;B组12~24 h,15例）、治疗后患者（C组,15例）及健康对照组（D组,15例）外周血嗜碱粒细胞CD63+和CD203c+的表达情况。结果：A、B、C三组外周血嗜碱粒细胞CD63+和CD203c+活化百分率（0.097±0.019,0.072±0.015,0.051±0.012）均高于对照D组（0.007±0.002,P<0.05）。A、B、C三组之间两两比较无显著差异（P>0.05）。结论：活化的嗜碱粒细胞可能参与了慢性自发性荨麻疹的发病过程,但与风团的持续时间无相关性。     

慢性自发性荨麻疹的严重程度及预后影响因素研究进展

慢性自发性荨麻疹是临床上常见的疾病,与肥大细胞激活有关,慢性自发性荨麻疹的不可预测性及病程迁延给患者带来了很大的困扰,并严重影响患者的身心健康.一些临床相关因素(如年龄、病程、早期使用激素治疗、是否合并可诱导荨麻疹、自身免疫性疾病)以及实验室生物学相关因素(如凝血功能异常,血清中维生素D、白介素-24等的水平)对于慢性...     

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.     

地氯雷他定联合奥马珠单抗治疗慢性自发性荨麻疹的临床观察

目的 观察地氯雷他定联合奥马珠单抗治疗慢性自发性荨麻疹的临床疗效和安全性.方法 将慢性自发性荨麻疹患者60例随机分为观察组和对照组各30例.观察组采用口服地氯雷他定片(5 mg,每日1次)联合皮下注射奥马珠单抗注射液(300 mg,4周1次)治疗,对照组仅口服地氯雷他定片(5 mg,每日1次),12周后观察两组临床疗效...