特应性皮炎张氏诊断标准在苏南地区青少年和成人的适用性评估

【摘要】 目的 评估特应性皮炎（AD）张氏诊断标准在苏南地区青少年和成人的适用性。方法 收集2019年5月至2021年5月来自苏南地区7家医院皮肤科初诊为湿疹或AD的病例1 769例。由研究人员自行设计调查表,主要包括患者的个人信息、相关病史及临床特征、实验室检查等内容,由患者和皮肤科医生共同完成标准化问卷。以Hanifin-Rajka标准为金标准,分别评估Williams标准、张氏标准、日本皮肤病学会标准的敏感性和特异性。结果 1 769例患者中男759例（42.9%）,女1 010例（57.1%）,年龄（32.2 ± 8.2）岁（12 ~ 79岁）。AD患者的临床特征中瘙痒的发生率占首位（96.7%,883/913）。以Hanifin-Rajka标准为“金标准”,913例（51.6%）被诊断为AD;张氏标准诊断敏感性为92.6%（845/913）,特异性为73.2%（627/856）;Williams标准诊断敏感性为87.8%（802/913）,特异性为81.3%（696/856）;JDA标准敏感性为96.9%（885/913）,特异性为68.9%（590/856）。张氏标准与Williams标准诊断一致性一般（Kappa值 = 0.61,P = 0.009）,张氏标准与JDA标准诊断一致性高（Kappa值 = 0.85,P = 0.001）,Williams标准与JDA标准诊断一致性一般（Kappa值 = 0.51,P = 0.013）。结论 与Hanifin-Rajka标准相比,张氏标准对于苏南地区青少年和成人AD的诊断表现出良好的敏感性和特异性,但瘙痒对AD的诊断亦非常重要。     

特应性皮炎的诊断标准发展及评价北大核心CSCD

任何一种需要建立诊断标准的疾病,一定是有多种表现的异质性疾病,如系统性红斑狼疮、白塞病等。特应性皮炎（atopicdermatitis,AD）是一种异质性疾病,该病也称特应性湿疹（atopiceczema,AE）,其异质性首先是皮损表现多种多样,有屈侧皮炎、手足皮炎、痒疹样皮疹、泛发性湿疹等,其次,患者还可能有其他特应性疾病,如过敏性鼻炎、哮喘,还可伴有外周血嗜酸性粒细胞升高、血清IgE水平升高、抗原特异性IgE阳性等,家族成员中也常有过敏性疾病史。正是由于这种复杂性和异质性,使得制定AD诊断标准成为必要。     

卡介菌多糖核酸联合NB-UVB照射对特应性皮炎的疗效及外周血嗜酸性粒细胞的作用

目的观察卡介菌多糖核酸联合窄谱中波紫外线(NB-UVB)照射后特应性皮炎(AD)患者的疗效及外周血嗜酸性粒细胞计数的变化情况,为治疗特应性皮炎提供指导依据。方法将入选患者随机分为两组,各39例。治疗组予卡介菌多糖核酸联合窄谱中波紫外线照射治疗,对照组仅予窄谱中波紫外线照射治疗,两组的疗程均为8周。采用SCORAD计分系统对AD临床严重程度进行评估;采用视觉模拟尺度(VAS)评分法对瘙痒程度进行评价,并分别于治疗前后检测两组患者外周血嗜酸性粒细胞水平比较。结果治疗8周后,治疗组和对照组的有效率分别为82.05%和53.85%,差异有统计学意义(P<0.01);治疗组外周血嗜酸性粒细胞水平(221.65±43.51)明显低于对照组(294.35±60.21)和治疗前(376.21±119.34),差异均有统计学意义(P均<0.01);但治疗前两组患者的外周血嗜酸性粒细胞水平(376.21±119.34和353.32±131.33)差异无统计学意义(P>0.05)。结论卡介菌多糖核酸联合窄谱中波紫外线照射可明显提高特应性皮炎患者的疗效,显著降低其外周血嗜酸性粒细胞水平。     

特应性皮炎的主动免疫疗法

特应性皮炎（atopic dermatitis,AD）又称为异位性皮炎,除有特定的皮炎湿疹表现外,患者本人或其家族中可见到明显的异位性特征,即：有容易罹患哮喘,过敏性鼻炎、湿疹的家族性倾向;对异种蛋白过敏;血清中IgE升高;血液嗜酸性粒细胞增多。     

40例成人发病型特应性皮炎患者外周血嗜酸性粒细胞和血清总IgE的检测

目的:探讨外周血嗜酸性粒细胞(EOS)和血清总IgE与成人发病型特应性皮炎(AD)的关系.方法:选取首次发病年龄>18岁的40例AD患者作为病例组,30例健康成年体检者作为对照组,检测两组外周血EOS和血清总IgE水平,比较性别、年龄、外周血EOS和血清总IgE水平在病例组和对照组以及不同疾病严重程度、伴/不伴呼吸道过...     

14~55岁特应性皮炎患者严重程度与维生素D、总IgE和嗜酸性粒细胞的相关性

目的探究青少年及成人特应性皮炎患者疾病严重程度与血清25-羟基维生素D、总IgE和嗜酸性粒细胞计数的相关性。方法参考SCORAD评分法评估112例青少年及成人特应性皮炎患者疾病严重程度,并检测患者及70例健康组血清25-羟基维生素D水平以及患者总IgE、嗜酸性粒细胞数计数。结果特应性皮炎组患者血清25-羟基维生素D水平(20.42±6.96)ng/mL明显低于健康组(28.68±7.85)ng/mL,差异有统计学意义(P=0.000<0.01)。重度患者血清25-羟基维生素D水平(18.93±7.06)ng/mL低于轻中度患者(21.62±6.70)ng/mL,差异有统计学意义(P=0.041<0.05);重度患者总IgE水平(5184.08±7533.82)IU/mL明显高于轻中度患者(1075.07±1777.37)IU/mL,差异有统计学意义(P=0.000<0.01);重度患者嗜酸性粒细胞计数升高(37/50)的比例明显高于轻中度患者(17/62),差异有统计学意义(P=0.000<0.01);血清25-羟基维生素D、总IgE、嗜酸性粒细胞计数均与SCORAD评分相关。结论青少年及成人特应性皮炎患者的血清25-羟基维生素D水平较健康人明显偏低,且与病情严重程度呈负相关;总IgE、嗜酸性粒细胞计数与病情严重程度呈正相关。     

特应性皮炎患者ECP、tIgE、sIgE、EOS的检测及意义

目的 通过检测特应性皮炎患者及正常对照组血中嗜酸粒细胞阳离子蛋白(ECP)、总IgE(tIgE)、变应原特异性IgE(sIgE)及外周血嗜酸粒细胞(EOS)计数的水平,探讨其变化在特应性皮炎发生发展中的重要意义。方法 采用酶联免疫法检测101例特应性皮炎患者及40例正常对照者血清ECP、IgE浓度,采用免疫印迹法检测其变应原特异性IgE的水平,采用传统方法计数外周血嗜酸粒细胞,并对检测结果进行统计学分析。结果 特应性皮炎患者ECP、tIgE浓度明显高于正常对照组(P<0.05),嗜酸粒细胞计数与正常对照组相比差别无统计学意义(P>0.05),101例患者中69例患者至少对一种变应原呈阳性反应(68.31%),有45例患者检出对2～7种变应原呈阳性反应(44.56%),正常对照组的特异性IgE检测全部为阴性。结论 ECP、tIgE、sIgE、EOS检测在特应性皮炎的发病机制研究及病情监测中起一定作用。     

女性外阴慢性单纯性苔藓的临床研究

【摘要】 目的 分析女性外阴慢性单纯性苔藓（VLSC）的临床特征。方法 回顾分析2017—2018年就诊于北京医院皮肤科外阴专病门诊的137例VLSC患者的临床特征。不符合正态分布的计量资料（年龄、病程）以M（P25,P75）表示,采用秩和检验比较,计数资料的比较采用χ2检验。结果 137例患者发病年龄32.0（25.5,40.0）岁,病程36.0（15.0,72.0）个月。32例（23.4%）有特应性疾病史,其VLSC发病年龄［29.5（25.0,35.8）］早于无特应性疾病患者［33.0（27.0,41.0）,Z = 2.03,P = 0.042］。皮损特征方面,130例（94.9%）累及大阴唇,13例（9.5%）累及小阴唇,103例（75.2%）皮损双侧分布,8例（5.8%）出现色素减退。所有患者均有不同程度瘙痒,中度瘙痒44例（32.1%）、重度80例（58.4%）,重度瘙痒患者占病程 > 2年患者的比例（68.1%）高于病程 < 2年的患者（47.7%）,差异有统计学意义（χ2 = 5.83,P = 0.016）。患者自觉诱发瘙痒加重因素包括,局部潮湿出汗（55例,40.1%）、进食辛辣刺激食物（41例,29.9%）、精神紧张（36例,26.3%）。结论 VLSC好发于20 ~ 39岁,特应性体质可能是重要病因,主要累及大阴唇,多双侧分布,病程越长瘙痒越严重。     

婴幼儿特应性皮炎血清25-羟维生素D_3水平及其与免疫球蛋白E和白细胞介素-17的相关性研究

<正>特应性皮炎(AD)是一种复发性、瘙痒性、炎症性皮肤疾病,皮疹呈多形性,可伴有渗出倾向。AD多自婴儿期起病,约50%患儿1岁前发病。AD病情迁延反复,发病与环境、遗传及免疫关系密切。免疫调节功能异常是AD的主要特点,目前认为主要是辅助性T细胞(Th)1及Th2之间平衡失调。AD皮损组织病理示真皮层可见CD4淋巴细胞及嗜酸性粒细胞,CD4淋巴细胞可分化为Th1和Th2,但主要转化为Th2。而Th2反     

特应性疾病中性粒细胞酶的研究

研究２０例特应性疾病，８例患者的双亲及１０例正常人中性粒细胞（ＰＭＮ）光镜细胞化学结果：全部患者髓过氧化物酶（ＭＰＯ）和酸性磷酸酶（ＡＣＰ）性显著降低；两者无线性相关，碱性磷酸酶恬性正常。７／８例的双新或其一方ＰＭＮ有类缺陷。结果表明：特应性疾病中ＰＭＮ嗜天青颗粒的ＭＰＯ和ＡＣＰ有原发性、联合性和部分性缺陷。推测该缺陷导致ＰＭＮ杀菌力降低和杀菌延缓；异物降解不全；形成抗原特性，成为特应性疾病中感染     

儿童中重度特应性皮炎首次皮下注射度普利尤单抗短期疗效和安全性分析

目的:了解度普利尤单抗皮下注射治疗儿童中重度特应性皮炎（AD）的短期疗效及安全性。方法:采用回顾性研究设计,收集2021年3 - 8月于首都医科大学附属北京儿童医院皮肤科诊断为中重度AD且同时接受度普利尤单抗注射液皮下注射治疗的患儿临床资料,评估度普利尤单抗注射液首次皮下注射治疗前、治疗后4周患儿湿疹面积及严重程度指数...     

度普利尤单抗治疗中重度老年特应性皮炎临床疗效观察

目的观察度普利尤单抗治疗中重度老年特应性皮炎(AD)的临床疗效及安全性。方法本研究为观察性研究, 纳入2021年9月至2022年6月于苏州大学附属第一医院皮肤科就诊的中重度老年AD患者42例, 均予度普利尤单抗首次皮下注射600 mg, 随后300 mg/2周, 总疗程为16周。于第0、4、8、12、16周记录患者临床指标, 包括湿疹面积与严重程度指数(EASI)、瘙痒数值评分量表(NRS)、皮肤病生活质量指数(DLQI)、研究者整体评分(IGA), 并统计EASI改善超过50%(EASI-50)和75%(EASI-75)的患者比例;于第0、4、16周检测患者血清总IgE水平和嗜酸性粒细胞计数, 观察患者不良事件发生情况。使用SPSS27、GraphPad Prism 9.0软件, 通过χ2检验、单因素ANOVA检验、t检验进行统计学分析。结果 42例患者中, 男25例(59.5%), 女17例(40.5%), 年龄(71.82 ± 16.81)岁。其中, 泛发性湿疹表型17例(40.5%), 屈侧湿疹表型15例(35.7%), 结节性痒疹表型10例(23.8%)。经治后, 第4和16...     

特应性皮炎患者血浆中P物质的测定及其临床意义

目的 探讨特应性皮炎患者血清中P物质水平及其临床意义.方法 用放射免疫法测定35例特应性皮炎患者血浆中P物质浓度,观察P物质与疾病严重程度积分及嗜酸粒细胞数的关系.结果 特应性皮炎患者血浆中P物质浓度明显高于正常人对照P<0.01),且疾病的EASI评分和Rajka严重度积分与P物质浓度呈显著正相关,r分别为0.95和0.86,P均<0.01.特应性皮炎患者外周血嗜酸粒细胞数明显高于正常人对照(P<0.01),并且与疾病的严重度呈正相关(与EASI评分r=0.42,P=0.011,与Rajka严重度积分r=0.42,P=0.013):特应性皮炎患者血浆中P物质浓度与外周血嗜酸粒细胞数呈正相关(r=0.43,P=0.009).结论 P物质对判断特应性皮炎活动性可能有一定价值;P物质可能与嗜酸粒细胞共同参与特应性皮炎发病.     

Adult-onset atopic dermatitis

Adult-onset atopic dermatitis (AD) is a recently introduced subgroup of AD. Apart from the most typical flexural lichenified/exudative pattern in adults, patients may also have nontypical morphology and localization. The aim of this retrospective study was to find the frequency of nontypical morphology and localization in adult-onset AD and to evaluate the accuracy of United Kingdom Working Party's criteria in detecting those cases. Among 376 patients consecutively diagnosed with AD according to criteria of a previous study, 63 patients (34 women and 29 men) (16.8%) with onset of AD after the age of 18 years were allocated to the adult-onset group. A total of 7 patients (11.1%) had nonflexural involvement with nummular (6.3%), prurigo-like (3.2%), or follicular (1.6%) patterns that could not be attributed to contact sensitivities. A total of 14 patients (22.2%) did not fulfill the United Kingdom Working Party's criteria. It was interesting that United Kingdom Working Party's criteria did not cover the same patients as did the previous study's criteria in nearly one fourth of the cases.     

Phenotypes of atopic dermatitis identified by cluster analysis in early childhood

Atopic dermatitis is a chronic, relapsing, inflammatory skin disease that usually appears in early childhood and develops into a heterogeneous disease during childhood. The clinical course and treatment for atopic dermatitis can differ according to its phenotype and/or endotype. This study aimed to identify clinical phenotypes of atopic dermatitis in early childhood. Data were obtained from 572 children under 3 years of age with atopic dermatitis. Cluster analysis applied to 11 variables, and we identified four clusters of atopic dermatitis. Children in cluster A (n = 141) had early‐onset atopic dermatitis with high blood eosinophil counts, serum total immunoglobulin E and rates of sensitization to food allergens. Children in cluster B (n = 218) had early‐onset atopic dermatitis with low blood eosinophil counts, serum total immunoglobulin E and rates of sensitization to both food and inhalant allergens. Children in cluster C (n = 53) had early‐onset atopic dermatitis with high C‐reactive protein levels and white blood cell counts. Children in cluster D (n = 160) had middle‐onset atopic dermatitis with high serum total immunoglobulin E and rates of sensitization to inhalant allergens. Cluster A had the highest Scoring for Atopic Dermatitis and transepidermal water loss values. Age at onset, age at diagnosis, white blood cell count, eosinophil count, C‐reactive protein and serum total immunoglobulin E level were the strongest predictors of cluster assignment. Analysis of these six variables alone resulted in correct classification of 95.5% of the subjects. These results support the heterogeneity of atopic dermatitis, even in early childhood.     

Prognostic factor of adult patients with atopic dermatitis

The increased prevalence of atopic dermatitis (AD) in adults in recent decades suggests that dermatologists may be expected to estimate the prognosis of adult patients with AD when they visit as new patients. We therefore evaluated the change in the extent of involvement and analyzed the factors that contribute to the prognosis of adult AD. A retrospective chart review was performed for 65 adults patients (median age at first visit, 25 years) with AD who had been followed monthly for over 10 years. The median area of involvement at first visit was 19%. The area of the eruptions and peripheral eosinophil counts decreased significantly in the fifth and 10th years with standard treatment. The values of immunoglobulin (Ig)E were also reduced after 10 years. Patients with high values of serum total IgE and peripheral eosinophil count, and long duration of AD had wide areas of eruptions 10 years after the first visit. Total IgE had the highest correlation with area of involvement after 10 years. Although the prognosis of adult AD is not poor, patients with high IgE values are expected to have ongoing eczema with wide distribution after 10 years of follow up.     

The disease burden of pediatric patients with atopic dermatitis in Japan

Background

Atopic dermatitis (AD) is a chronic skin condition that is associated with significant patient burden and decreased health-related quality of life (HRQoL). We report results of the real-world Epidemiology of Children with Atopic Dermatitis Reporting on their Experience study in Japanese pediatric patients, focusing on the impact of AD severity on disease burden.

Methods

Children and adolescents aged 6 months to 17 years (or their caregivers/parents) completed an online survey between September 26, 2018, and March 5, 2019. Patients with diagnosed AD (i.e., met International Study of Asthma and Allergies in Childhood criteria and had a self-reported AD diagnosis) were evaluated for disease severity using the Patient-Oriented Eczema Measure (POEM). Impact of AD severity on AD symptoms (itching, pain, and sleep disturbance), disease flares, atopic comorbidities, healthcare resource utilization, school days missed, and HRQoL were assessed.

Results

Of 5702 Japanese pediatric patients, 547 had diagnosed AD and were included in this analysis. Based on POEM scores, AD severity was clear/mild in 346 patients (63.3%), moderate in 177 (32.5%), and severe in 24 (4.4%). Across all age groups (i.e., less than 6, 6–11, and 12–17 years), increased AD severity was associated with increased AD symptom severity, number of flares, atopic comorbidities, healthcare resource utilization, and school absences, as well as worsened HRQoL.

Conclusions

This population-based study of Japanese children and adolescents showed that greater AD severity had a high impact on disease burden.     

Evaluation of diagnostic criteria for atopic dermatitis: validity of the criteria of Williams et al. in a hospital-based setting

BACKGROUND: Surveys of the prevalence of atopic dermatitis (AD) have been carried out world-wide, but the results vary widely. The differences probably result from the use of different diagnostic criteria. Williams et al. proposed minimum, simplified, diagnostic criteria that require no invasive test and are easy to use. Pilot studies in European countries showed their suitability for implementation both in hospitals and in the community, and their high sensitivity and specificity. OBJECTIVES: To evaluate the potential practical value of the criteria of Williams et al. in the Chinese population. METHODS: The criteria of Hanifin and Rajka (gold standard), Williams et al. and Kang and Tian were applied and compared in 111 patients with AD and 121 control subjects with other skin diseases in three out-patient centres in China. RESULTS: The criteria of Williams et al. showed a similar diagnostic efficiency to that of the gold standard, with the sensitivity, specificity and kappa value reaching 95.50%, 97.52% and 0.93, respectively. No significant difference was found between the criteria of Williams et al. and those of Kang and Tian (chi2 = 0.69, P > 0.05). 'Onset under the age of 2 years', a criterion of Williams et al. could be used in subjects of any age. CONCLUSIONS: The diagnostic efficiency of the criteria of Williams et al. was basically similar to those of Hanifin and Rajka and of Kang and Tian in our out-patient settings. However, those of Williams et al. were easier to apply and required no invasive tests.     

特应性皮炎的转录组学研究进展

【摘要】 随着基因芯片技术、RNA测序技术等转录组学技术发展,特应性皮炎（AD）发病中重要的相关影响因素逐渐被揭示,如不同T辅助（Th）细胞的亚型以及其他免疫相关细胞如巨噬细胞、朗格汉斯细胞;在AD的瘙痒及皮肤屏障破坏方面,相关免疫细胞如Th2细胞及角质形成细胞等所释放白细胞介素4、白细胞介素13、聚丝蛋白、兜甲蛋白等活性物质的异常变化起着主要作用。同时,转录组技术已被用于分析患者治疗前后转录谱的变化从而对患者的病情和治疗效果进行评估等。本文总结近年来在AD转录组学方面的研究进展。