雷公藤多甙片联合地氯雷他定治疗慢性特发性荨麻疹疗效观察

目的观察雷公藤多甙片联合地氯雷他定治疗慢性特发性荨麻疹的临床疗效和安全性。方法共入选180例患者,将其随机分成两组,每组各90例,治疗组予雷公藤多甙片10mg口服,3次/d,地氯雷他定5mg口服,1次/d,均连用28天;对照组仅予地氯雷他定5mg口服,1次/d,连用28天。结果治疗第7天时治疗组有效率为69.77%,对照组为54.02%;第14天时治疗组有效率82.56%,对照组59.77%;第28天时治疗组有效率93.02%,对照组67.82%。两组患者在治疗第7,14和28天时有效率比较,差异均有统计学意义(P均<0.05)。患者主观生活质量评估在治疗14天后DLQI和睡眠情况改善明显好于对照组,28天后DLQI、睡眠情况和日常活动评分也明显好于对照组(P均<0.05)。不良反应:治疗组发生率为8.14%,对照组为6.90%,两组差异无统计学意义。停药6周后进行随访和复诊,试验组复发率低于对照组,差异有统计学意义(P<0.05)。结论雷公藤多甙片联合地氯雷他定治疗慢性特发性荨麻疹的临床疗效比单纯应用地氯雷他定治疗的疗效好,停药后复发率低。     

地洛他定治疗慢性特发性荨麻疹的疗效及安全性研究

目的　观察地洛他定治疗慢性特发性荨麻疹的疗效和安全性 ,并与氯雷他定进行比较。方法　采用多中心、随机双盲、平行对照法。结果　完成治疗者共 15 8例 ,其中地洛他定组 79例。治疗后 ,患者主、客观症状观察项目平均积分于服药第 14、2 8天均有下降 ,但两组比较均无统计学意义 (P >0 .0 5 )。治疗结束时 ,地洛他定组痊愈 60例(75 .95 % ) ,总有效率 89.87% (71/79) ;氯雷他定组痊愈 5 4例 (68.3 5 % ) ,总有效率为 87.3 4% (69/79)。两组比较差异无显著性 (χ2 =0 .3 ,P >0 .0 5 )。结论　地洛他定是一种对慢性特发性荨麻疹有良好疗效且安全的药物     

地氯雷他定干混悬剂联合复方甘草酸苷治疗小儿慢性特发性荨麻疹疗效观察

目的探讨地氯雷他定干混悬剂联合复方甘草酸苷治疗小儿慢性特发性荨麻疹的临床疗效和安全性。方法将76例慢性特发性荨麻疹患者随机分为两组,治疗组和对照组均口服地氯雷他定干混悬剂,2~5岁小儿,1.25 mg/次,1次/d;6~11岁小儿,2.5 mg/次,1次/d;治疗组同时口服复方甘草酸苷胶囊,1粒/次,3次/d。观察治疗第14,28天的临床疗效和不良反应。结果治疗组和对照组治疗后第14天的有效率分别为73.68%和65.79%,两组比较差异无统计学意义(P0.05);治疗后第28天,治疗组的有效率为92.11%,对照组为68.42%,两组比较差异有统计学意义(P0.01)。结论地氯雷他定干混悬剂联合复方甘草酸苷治疗小儿慢性特发性荨麻疹是安全有效的。     

阿司咪唑与氯雷他定治疗慢性荨麻疹的疗效及安全性研究

目的 进一步观察阿司咪唑治疗慢性荨麻疹的疗效和安全性，并与氯雷他定进行比较。方法 采用多中心、随机双盲、平行对照试验，结果 11个试验中心共完成合格病例429例，其中阿司咪组215例，氯雷他定组214例。治疗后，患者主、客观症状观察项目平均积分于服药第7、14、21、28天均有下降，但两组间比较（除皮肤划痕外）均无统计学意义（P＞0．05）；停药14天后各项指标（除白天瘙痒外），两组比较阿司咪唑组明显优于氯雷他定组，且具有统计学意义（P＝0．0006－0．0476）。治疗结束时，阿司咪唑组痊愈106（49．30％）例，总有效率为（73．95％）159／215；氯雷他定组痊愈105（49．07％）例，总有效率为（70．09％）150／214。两组间比较差异无统计学意义（P＞0．05）。结论 口服阿司咪唑或氯雷他定治疗慢性荨麻疹均具有良好疗效和安全性，但阿司咪唑停药14天后对症状控制明显优于氯雷他定。     

Onychodystrophy as the only sign of congenital candidiasis

Congenital candidiasis infection often presents as a skin rash with variable involvement of nails and mucous membranes. Isolated nail involvement is rare, may present late, and can often be managed with topical antifungal medication. We report a case of congenital candidiasis limited to the fingernails that resolved completely within 3 months with topical treatment.     

慢性特发性荨麻疹患者外周血单一核细胞干扰素-γ受体mRNA表达

目的探讨慢性特发性荨麻疹(CIU)患者外周血单一核细胞(PBMC)干扰素-γ受体(IFN-γR)mRNA表达情况。方法收集45例CIU患者,38例正常人作为对照,采集PBMC提取RNA,应用逆转录聚合酶链扩增(RT-PCR)法检测IFNR mRNA表达水平。结果CIU患者PBMC中Th1细胞因子受体IFN-γR mRNA表达水平(0.636±0.194),高于健康对照组(0.540±0.184)(t=2.315,P(0.05)。结论CIU患者PBMC中IFN-γR的mRNA表达增高,可能与该病发病机制有关。     

Usefulness of the Autologous Serum Test for the Diagnosis of Chronic Idiopathic Urticaria

Background

The majority of chronic urticaria cases are chronic idiopathic urticaria (CIU) with no specific identifiable etiology. The role of autoantibodies in such cases remains controversial.

Objective

This study determined the positivity rate of autologous serum tests in CIU patients.

Methods

This study was performed on 30 patients with CIU and 30 individuals without any systemic or dermatologic disease. After the volar parts of right and left forearms were cleansed, 0.05 ml serum physiologic and 0.05 ml autologous serum were injected intradermally on the right forearm 5 cm apart from each other, resulting in the formation of small papules; meanwhile, 0.05 ml histamine alone was injected to the left forearm. The test results were evaluated after 30 minutes as positive in positive cases.

Results

The autologous serum test produced significant and non-significant results in patients with CIU and controls, respectively. The positivity rates of the autologous serum test in the CIU and control groups were 53.3% and 26.6%, respectively. There was no relationship between autologous serum test positivity and sex in either group. In male patients with CIU, positive results ranged widely with age, while in female patients, positive results were mainly observed at younger ages with a narrow age range.

Conclusion

The autologous serum test is a useful test in the diagnosis and treatment of CIU as well as the selection of immunotherapy, especially in patients refractory to classic therapy.     

卡介菌多糖核酸联合咪唑斯汀治疗慢性特发性荨麻疹疗效及安全性研究

目的探讨卡介菌多糖核酸联合咪唑斯汀治疗慢性特发性荨麻疹的治疗效果及安全性。方法纳入我院2013年1月—2014年11月确诊为慢性特发性荨麻疹的患者150例,随机平均分为2组,其中观察组75例,予隔天臀部肌内注射卡介菌多糖酸2 m L并联合每天口服咪唑斯汀10 mg;对照组75例,予每天咪唑斯汀10 mg口服,2组均连续治疗4周。分别于治疗前、治疗后2周、4周及3个月共4个时间点观察2组患者的症状积分的变化情况及有效率,并对2组的不良反应等安全性情况进行分析。结果治疗后2周、4周和3个月2组患者的症状积分和有效率与治疗前比较差异有统计学意义(P<0.05);治疗后2周观察者与对照组症状积分和有效率2组比较差异无统计学意义(P>0.05),而治疗后4周和3个月2组的症状积分和有效率比较差异有统计学意义(P<0.05);2组均未发现严重的不良反应,其中观察组有10例患者、对照组有8例患者出现了轻度的嗜睡现象,观察组、对照组各有2例出现了头痛现象,均未做任何特殊处理,停药后症状消失。所有患者的肝肾功能等实验室检查均无异常表现。结论卡介菌多糖核酸联合咪唑斯汀治疗慢性特发性荨麻疹疗效确切且安全性高。     

慢性前列腺炎患者5种支原体检测

目的 了解慢性前列腺炎与5种支原体感染的相关性。方法 采用巢式聚合酶链反应法（nPCR)检测慢性前列腺炎（CIP）患者前列腺液中UU、MG、MPN、MH和MF5种支原体。结果 48例CIP中31例支原体阳性，阳性率64.6%；其中UU阳性20例、MG阳性5例，MPN阳性5例、MH阳性4例、MF阳性3例；UU MG阳性2例，UU MH阳性1例，MPN MF阳性1例，UU MG MPN阳性1例。结论 支原体感染是CIP的重要致病原因，应当引起重视；用1种通用引物查5种支原体有较大的临床应用价值。     

慢性特发性荨麻疹与幽门螺杆菌关系和治疗的研究

目的探讨慢性特发性荨麻疹(chronic idiopathic urticaria,CIU)与幽门螺杆菌(Helicobacter pylori,HP)关系及其治疗效果.方法 300例CIU患者进行14碳-尿素呼气试验(14C urea-breath test,14C-UBT),176例HP阳性者随机分为三组,其中58例予抗过敏治疗、59例抗过敏联合三联疗法治疗、59例中药联合三联疗法治疗,观察内容包括瘙痒、风团数量、风团大小、风团持续时间,比较各组治疗效果、分析CIU与HP之间关系.另外57例CIU患者进行自身血清抗体检测,其中35例HP阳性者予抗过敏联合三联疗法治疗,相同治疗方法与呼气试验组比较转阴率.108例健康体检者作为对照(其中65例进行呼气试验,43例血清抗体检测),以便对HP阳性率进行分析.结果CIU患者HP阳性率明显高于健康组(P＜0.01).联合三联疗法(抗过敏联合三联疗法、中药联合三联疗法)与单纯抗过敏治疗相比,治疗效果明显优于后者(P＜0.05),转阴率也明显高于后者(P＜0.01).治疗后HP转阴与未转阴患者疗效比较,前者明显优于后者(P＜0.05).结论 CIU与幽门螺杆菌关系密切,中药联合三联疗法治疗CIU效果好.     

Correlations between Anti-Mast Cell Autoantibodies and Chronic Idiopathic Urticaria

Background

The etiology of chronic idiopathic urticaria (CIU) is not completely clear. There are a few antibodies were reported to correlate with CIU.

Objective

To investigate the correlation these antibodies and CIU.

Methods

The autologous serum skin test (ASST) and allergens were performed. Serum levels of immunoglobulin E (IgE), anti-FcεRI and anti-IgE, anti-Helicobacter pylori (HP) antibodies and anti-thyroglobulin antibody (TGAb) were measured in 100 patients with CIU, acute urticaria (AU) and normal controls respectively.

Results

Eighty-six percent food or inhalant allergens were detected in AU patients, but no allergens were detected in CIU patients and normal controls. Serum anti-FcεRI antibody and anti-IgE antibody levels were higher in the CIU than that in the AU patients and normal controls (p<0.05, respectively). IgE level was lower in the CIU patients (T=190.00, p< 0.05), but increased in the AU patients (T=226.00, p<0.05) compared with the normal controls. The ASST positive rates in the CIU and the AU patients were 53.4% and 12.6% respectively, but all normal controls were negative. The anti-FcεRI antibody level was higher in the ASST-positive CIU patients than those negative ones (T=101.73, p<0.05). In anti-HP antibody positive and TGAb positive CIU patients, anti-FcεRI antibody positive rate was higher than AU patients (p<0.01) and normal controls (p<0.01).

Conclusion

The anti-FcεRI and anti-IgE antibodies play a key role in CIU, but anti-HP antibody and TGAb have an indirect correlation with CIU.     

Lack of Association of Plasma Histamine with Diamine Oxidase in Chronic Idiopathic Urticaria

Background

Chronic idiopathic urticaria (CIU) is considered a complex and multifactorial disease. Excessive histamine intake may induce an attack of urticaria. The main enzyme for histamine metabolism is diamine oxidase (DAO).

Objective

Plasma histamine concentrations and DAO activities were evaluated to determine whether there are abnormalities in the histamine metabolism of CIU patients.

Methods

Seventy-five CIU patients and twenty-five healthy control subjects were included in the study. Blood was taken from all subjects to measure plasma levels of the histamine and DAO.

Results

Mean plasma histamine levels were significantly higher in CIU patients (11.59±10.98 nM) than in the control subjects (8.75±2.55 nM) (p=0.04). Mean DAO activities were lower in patients of CIU (80.86±26.81 histamine degrading unit [HDU]/ml) than in the controls (81.60±9.67 HDU/ml), but without significant difference. In 15 CIU patients with gastrointestinal symptoms, the mean histamine concentration was higher (12.43±7.97 nM) and DAO activity was lower (77.93±27.53 HDU/ml) than in the remaining 60 CIU patients without gastrointestinal symptoms (11.38±11.67 nM and 81.58±26.82 HDU/ml), without significant difference. The relationship between DAO activity and plasma histamine concentrations showed a significant negative linear value (p=0.001). There were no significant relationships between plasma histamine concentrations and symptom severity score.

Conclusion

In CIU patients, a high plasma histamine concentration may not be explained by DAO activity. CIU patients with gastrointestinal (GI) symptoms showed no significantly lower DAO activity. Larger group studies are required to elucidate the relationship between plasma histamine concentrations and DAO activity, especially of CIU patients with GI symptomsto understand the difference in CIU patients with and without GI symptoms.     

慢性荨麻疹伴甲状腺疾病的诊治方法探讨

目的探讨总结慢性荨麻疹伴自身免疫性甲状腺疾病的诊治方法。方法对我院2000年~2004年收治的8例确诊为慢性荨麻疹伴甲状腺自身免疫性疾病的临床资料进行回顾性分析。结果8例中,7例的FT3(25.81±3.50)pmol/L,FT4(60.56±6.20)pmol/L,均明显高于正常值,uTSH(0.116±0.012)m IU/L明显低于正常值,给予抗甲亢、手术和抗组胺等同时治疗后,荨麻疹与甲亢症状消失。结论对于原因不明的慢性荨麻疹患者,应作甲状腺功能检查。若伴甲状腺疾病者应同时给予抗组胺并针对甲状腺疾病进行治疗。     

特发性多发性斑状色素沉着症1例

患者男,21岁。躯干、四肢近心端褐色斑2月。皮损首先发生在腹部,无自觉症状,病程中无红斑期。查体见躯干、四肢近心端泛发性褐色斑,上无明显鳞屑。背部皮损组织病理示:表皮下部色素轻度增多,真皮乳头层散在嗜色素细胞。诊断:特发性多发性斑状色素沉着症。     

特发性阴囊钙沉着症1例

患者男,34岁。阴囊出现淡黄色丘疹、结节5年,无不适。阴囊处丘疹组织病理示:表皮棘层肥厚,真皮内见一大片状嗜碱性无定形、团块状物质位于囊肿内,囊肿周围少许淋巴细胞及组织细胞浸润,囊内容物未见网篮状或板层状的角质物,真皮内未见异物巨细胞及基底样细胞团块。诊断:特发性阴囊钙沉着症。     

Chronic Idiopathic Urticaria and Thyroid Autoimmunity: Perplexing Association

Background:

Autologous serum skin test (ASST) is the most commonly used laboratory test to differentiate chronic autoimmune urticaria patients from chronic idiopathic urticaria patients without autoantibodies. Thyroid autoimmunity is the original paradigm for autoimmune disease in general and many previous studies show increased prevalence of thyroid autoantibodies and deranged thyroid hormone profile in chronic idiopathic urticaria patients.

Aim:

To find the association between thyroid autoimmunity and chronic autoimmune urticaria, if any.

Materials and Methods:

The chronic idiopathic urticaria patients were divided into two subgroups based on autologous serum skin test. Thyroid autoantibodies were estimated in 40 patients each of ASST positive and ASST negative groups. Further, thyroid hormone profile was done in cases with significant titers of thyroid autoantibodies. Forty patients, who had never suffered from urticaria, represented the control group.

Results:

The prevalence of thyroid autoantibodies did not differ significantly among the ASST positive (20%) and ASST negative patients (15%). The control group had low prevalence of these autoantibodies (5%).

Conclusion:

The almost equal prevalence of thyroid autoantibodies in two subgroups of chronic idiopathic urticaria patients suggests possibly the same etiopathogenesis of the two subgroups. The two subgroups probably form a continuum, or even may be the same entity.     

左西替利嗪、曲尼司特联合卡介苗素治疗慢性荨麻疹的临床观察

目的观察左西替利嗪、曲尼司特联合免疫调节剂卡介苗素治疗慢性荨麻疹的疗效。方法将入选的患者随机分为3组:治疗组56例,予口服左西替利嗪5mg1次/d、曲尼司特0.1g3次/d联合卡介苗素2mL肌肉注射隔日1次治疗;对照A组45例予口服左西替利嗪和曲尼司特治疗,对照B组45例单纯口服左西替利嗪治疗,方法均同治疗组。三组均用药8周后评价疗效,停药1月后观察复发情况。结果治疗组有效率91.1%,明显优于两个对照组((75.6%,42.2%)(P均0.05),差异有显著性;治疗组复发率(6/42例)低于两个对照组(9/26例,9/12例)。结论左西替利嗪、曲尼司特联合卡介苗素治疗慢性荨麻疹疗效好,复发率低。     

三种慢性变应性皮肤病患者食物不耐受结果分析

目的比较慢性湿疹、异位性皮炎及慢性荨麻疹患者对14种食物的不耐受情况。方法ELISA法检测3组患者和正常对照组血清中14种食物特异性IgG抗体,并进行等级判定以区分食物不耐受的程度。结果3组患者食物不耐受发病率和严重不耐受的发病率均显著高于正常对照组,异位性皮炎患者食物严重不耐受的发病率最高,达62.5%;三组患者对鸡蛋和牛奶的发病率最高,且不耐受的程度最严重,而异位性皮炎患者对鸡蛋和牛奶严重不耐受的发病率又显著高于另外两组患者;三组患者食物严重不耐受的发病均主要分布在婴幼儿组和青少年组,但异位性皮炎患者食物不耐受的发病年龄和异位性皮炎自身的发病年龄分布一致。结论食物不耐受和异位性皮炎的关系较为密切,提示食物不耐受在异位性皮炎的发病中可能占据较为重要的地位,但其确切机制有待进一步探讨。     

Idiopathic unilateral hyperhidrosis with Holmes-Adie syndrome: case report

Hyperhidrosis is a disease that is characterized by excessive sweating due to hyperactivation of eccrine sweat glands. It may be localized or generalized form. Holmes-Adie syndrome is an idiopathic disease with unilateral pupil dilatation and loss of deep tendon reflexes. We present a 37-year-old female patient diagnosed with unilateral hyperhidrosis coincident with Holmes-Adie syndrome because of this unusual presentation.