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。     

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。     

Increased levels of serum IL‐31 in chronic spontaneous urticaria*

Please cite this paper as: Increased levels of serum IL‐31 in chronic spontaneous urticaria. Experimental Dermatology 2010; 19: 464–466. Abstract: IL‐31 represents a novel cytokine involved in pruritic skin diseases including atopic dermatitis (AD). We, therefore, aimed at investigating IL‐31 levels in chronic spontaneous urticaria (CU). We included 46 patients with CU, 26 non‐atopic skin healthy subjects as negative and 28 patients with AD as positive controls. IL‐31 serum levels were analysed using commercial ELISA kit. IL‐31 serum levels were higher in patients with CU compared to healthy controls (P < 0.001), but lower compared to patients with AD (P < 0.001). There was no difference in IL‐31 serum levels in autologous serum skin test positive or negative CU patients and patients with infectious trigger factors including helicobacter pylori infection. IL‐31 serum levels may play a role in the pathophysiology of CU. This is supported by the finding that not all patients with CU respond to antihistamine treatment but to the treatment with immunosuppressive drugs.     

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。     

慢性荨麻疹患者血清中Ｄ-二聚体水平和IL-33表达及意义

 目的:探讨慢性荨麻疹（CU）患者血清中D-二聚体水平和 IL-33的水平及其临床意义。方法:将63例CU患者依据自身血清皮肤试验（ASST）结果进行分组,取同期体检健康者作为对照组,采用ELISA法检测三组患者血清中D-二聚体水平和 IL-33水平并进行比较。结果:63例CU患者中,37例ASST阳性（58.73%）,26例阴性（41.27%）。相比对照组D-二聚体水平［2.437 ±0.120） mg/L］,ASST（+）组 ［（25.797±7.756） mg/L］和ASST（-）组［（30.605±9.101）mg/L］均明显增加（t值分别为10.25、10.58,P值均<0.05）,但ASST（-）组与ASST（+）组两组间无明显差异（t=1.39, P＞0.05）。ASST（+）组血清中IL-33含量 ［（0.237±0.037） pg/mL］明显高于对照组［（0.069±0.001） pg/mL］,t=7.78,P<0.05,而ASST（-）组IL-33水平［（0.112±0.028） pg/mL］无明显变化（t=2.63, P＞0.05）,ASST（-）和ASST（+）间有明显差异（t=4.69, P<0.05）。结论:CU患者血清中D-二聚体水平及ASST（+）组IL-33水平升高,可能导致机体免疫系统失衡,在CU的发生与发展中发挥一定作用。     

几种炎症因子与慢性荨麻疹的相关性

目的:明确几种炎症因子与慢性荨麻疹(CU)的相关性。方法:采用ELISA法检测40例CU患者以及40名正常对照者血浆C5a水平以及血清C3、C4、ESR、抗溶血性链球菌O(ASO)、C-反应蛋白(CRP)、类风湿因子(RF)水平,分析其与CU症状评分的相关性。结果:与正常对照者比较,CU患者血浆C5a水平以及血清C4水平明显升高(P0.01),而血清C3水平无统计学差异(P0.05);患者ESR以及CRP水平明显升高(P0.01和P0.05);血清ASO以及RF水平无统计学差异(P0.05)。CU患者的ESR以及CRP水平与症状评分相关(P0.01)。结论:慢性荨麻疹患者中存在补体激活和系统性炎症反应。     

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.     

慢性荨麻疹患者多种因素致敏状态研究

慢性荨麻疹是指病程超过6周的荨麻疹,多迁延难愈,对常规抗组胺药有时治疗效果不显著.为了了解慢性荨麻疹患者的致敏状态,我科对193例慢性荨麻疹患者进行了食物、吸入物特异性IgE检测、自体血清皮肤试验及斑贴试验.     

Cellular adhesion molecules in chronic urticaria: modulation of serum levels occurs during levocetirizine treatment

BACKGROUND: Some antihistamines are capable of reducing levels of adhesion molecules in wealing tissues of patients with chronic urticaria (CU). OBJECTIVES: To determine if 6 weeks of therapy with levocetirizine 5 mg once daily would also induce any decrease in serum levels of intercellular adhesion molecule-1, vascular cell adhesion molecule-1, endothelial leucocyte adhesion molecule-1 (ELAM-1) or P-selectin in subjects with CU and chronic autoimmune urticaria. METHODS: Thirty-six patients with CU (18 with positive and 18 with negative autologous serum skin test) were studied, together with 10 control healthy subjects. All patients received levocetirizine 5 mg daily. Serum soluble cellular adhesion molecule (CAM) levels were determined by immunoenzymatic assay before and after the end of the study period. Disease activity was recorded according to the EAACI/GA(2)LEN/EDF scoring system. RESULTS: After levocetirizine therapy CAM levels decreased in patients with CU, significantly in the cases of ELAM-1 and P-selectin. Patients' clinical scores improved during regular antihistamine therapy. CONCLUSIONS: Levocetirizine 5 mg daily demonstrated a broad anti-inflammatory effect in patients with CU. The significant decrease in serum levels of ELAM-1 and P-selectin might reflect the inhibitory activity on neutrophil rolling and extravasation towards inflamed skin.     

慢性荨麻疹患者甲状腺自身抗体测定及自体血清皮肤试验的意义

目的 :　探讨慢性荨麻疹患者甲状腺自身抗体及自体血清皮肤试验的意义。方法 :　采用放射免疫法 ,对 6 0例慢性荨麻疹患者的甲状腺激素自身抗体及功能进行检测 ;对甲状腺自身抗体阳性的慢性荨麻疹患者进行自体血清皮肤试验。结果 :　 6 0例慢性荨麻疹患者中甲状腺过氧化物酶抗体及促甲状腺受体自身抗体的阳性率分别为 2 1.7% (13 6 0 )和 15 % (9 6 0 ) ,均显著高于正常对照组 (P均 <0 .0 1)。 13例甲状腺自身抗体阳性的慢性荨麻疹患者自体血清皮肤试验 7例 (5 3.8% )阳性 ,显著高于自身抗体阴性对照组 (P <0 .0 1)。结论 :　甲状腺自身抗体的测定及自体血清皮肤试验对自身免疫性慢性荨麻疹有一定的诊断意义     

The autologous serum skin test in a cohort of chronic idiopathic urticaria patients compared to respiratory allergy patients and healthy individuals

BACKGROUND: A positive autologous serum skin test (ASST) is considered to reflect the presence of anti-FceRI and/or anti-IgE autoantibodies that are capable of activating mast and basophil cell degranulation. The ASST is regarded as a reliable in vivo test in chronic idiopathic urticaria (CIU) patients, with diagnostic, therapeutic and prognostic implications. However, positive ASST results have also occasionally been demonstrated in patients with other diseases and in healthy subjects. OBJECTIVE: To evaluate the specificity and sensitivity of the ASST in a cohort of CIU patients compared to a cohort of respiratory-allergic patients and a group of normal individuals. METHODS: ASST was performed in a cohort of 116 subjects, 47 subjects with seasonal allergic rhinitis, 32 respiratory-symptom-free CIU patients, and 37 healthy individuals. RESULTS: The results were compared statistically to those of the CIU patients. The intradermal injection of autologous serum induced a weal and flare reaction in 17/32 (53.1%) CIU patients; 14/47 (29.8%) patients with seasonal allergic rhinitis (P=0.06) and in 15/37 (40.5%) of the healthy controls (P=0.34). The sensitivity and specificity of the ASST in the CIU patients and the seasonal allergic rhinitis patients was 53 and 28%, respectively. When comparing the CIU patients with the healthy controls the sensitivity and specificity was 55 and 31%, respectively. The positive and negative predictive values of the ASST when comparing CIU patients with healthy controls were 53 and 59.5%, respectively. The positive and negative predictive values of the ASST in the CIU patients compared to seasonal allergic rhinitis patients were 53 and 70%, respectively. CONCLUSION: The relatively low sensitivity and specificity of the ASST in the CIU patients compared to the seasonal allergic rhinitis patients and healthy controls warrants a more critical interpretation of the ASST in chronic idiopathic urticaria.     

荨麻疹患者血清特异性IgE过敏原检测及两种氯雷他定的疗效比较

目的:了解322例荨麻疹患者的致病因素及各种因素之间的相互关系,比较2种氯雷他定治疗84例慢性特发性荨麻疹患者的疗效。方法:采用德国“敏筛”定量过敏原检测系统对322例荨麻疹患者进行了特异性IgE及过敏原的检测和分析,应用2种氯雷他定片治疗84例慢性特发性荨麻疹患者,并进行疗效对比和随访观察。结果:322例患者中有159例至少对1项过敏原阳性,阳性率为49.4%。平均阳性过敏原为(1.36±1.70)项;78例患者血清特异性总IgE阳性,阳性率为24.2%。2种氯雷他定片治疗前后患者症状和体征评分指数下降差异无统计学意义。治疗后,治疗组基愈率为37.2%,有效率为72.2%;对照组基愈率为39.0%,有效率为78.0%,两组疗效比较差异无统计学意义。结论:德国“敏筛”定量过敏原检测系统能较简便地检测特异性IgE和过敏原;国产氯雷他定治疗慢性特发性荨麻疹安全有效。     

慢性自发性荨麻疹患者血清中IL-31水平与瘙痒程度的相关性

目的:明确慢性自发性荨麻疹患者血清中IL-31水平与瘙痒程度的相关性。方法:采用ELISA法检测61例慢性自发性荨麻疹患者和59名健康体检者血清IL-31的含量,视觉模拟量表评价患者瘙痒程度。结果:荨麻疹患者血清IL-31水平为28.63±15.38 pg/mL高于对照组的1.74±0.30pg/mL,两组相比差异具有统计学意义(P0.001)。慢性自发性荨麻疹患者轻度、中度及重度瘙痒组IL-31水平分别为17.82±14.77 pg/mL,34.28±10.39 pg/mL和37.68±15.18 pg/mL,各组间差异有统计学意义(P0.05)。结论:慢性自发性荨麻疹患者瘙痒程度可能与血清IL-31的表达升高有关。     

Clinical characteristics of pruritus in chronic idiopathic urticaria

BACKGROUND: Although pruritus is a predominant symptom of chronic idiopathic urticaria (CIU) its clinical characteristics have not been explored. OBJECTIVES: To characterize the clinical pattern and sensory and affective dimensions of the itch experience, utilizing a comprehensive itch questionnaire. METHODS: A structured questionnaire based on the McGill pain questionnaire was used in 100 patients suffering from CIU randomly recruited from a tertiary referral centre. RESULTS: All 100 patients recruited with CIU completed the questionnaire. In 68 patients pruritus appeared on a daily basis. Most patients experienced their pruritus at night and in the evening (n = 83), and 62 reported difficulty in falling asleep. Pruritus involved all body areas, but mostly the arms (n = 86), back (n = 78) and legs (n = 75). Accompanying symptoms were a sensation of heat in 45 patients and sweating in 15. Most patients (n = 98) were prescribed antihistamines (mainly sedating), of whom 34 experienced long-term relief. The sensation of itch was reported to be stinging (n = 27), tickling (n = 25) and burning (n = 23). Seventy-six patients found their pruritus bothersome, 66 annoying and 14 complained of depression. The itch intensity at its peak was more than double that felt after a mosquito bite. The worst itch scores of those who felt depressed were significantly higher than of those who did not (P = 0.018). There was a positive correlation between the sensory and affective scores during worst itch (P < 0.001). CONCLUSIONS: This study describes the itch experienced in CIU, highlighting sensory and affective dimensions. The itch questionnaire was found to be a valuable tool for evaluating pruritus in CIU and its unique features.     

Methotrexate: a useful steroid-sparing agent in recalcitrant chronic urticaria

Background Reports of methotrexate for chronic urticaria are anecdotal. Objectives To assess the effectiveness of methotrexate in steroid‐dependent chronic urticaria, its impact on steroid reduction and any differences in response between patients with and without functional autoantibodies. Methods A retrospective case‐note review of 16 patients with steroid‐dependent chronic urticaria treated with methotrexate was carried out. Ten patients had chronic ordinary/spontaneous urticaria (CU), including three with associated delayed‐pressure urticaria; four patients had normocomplementaemic urticarial vasculitis (UV); and two patients had idiopathic angio‐oedema without weals. Median disease duration before methotrexate was 48·5 months (range 12–164). All were unresponsive to antihistamines and second‐line agents, except prednisolone. Eleven were assessed for autoimmune urticaria with the basophil histamine release assay (n = 5), autologous serum skin test (n = 5) or both (n = 1). Response to methotrexate was scored: no benefit; some benefit (fewer weals and symptomatic improvement but no steroid reduction); considerable benefit (improvement with steroid reduction); or clear (no symptoms, off steroids but on antihistamines). Results Twelve of 16 patients (eight CU, three UV, one idiopathic angio‐oedema) responded. Three showed some benefit, seven considerable benefit and two cleared. Four of eight responders and three out of three nonresponders showed evidence of functional autoantibodies. The dose to achieve a steroid‐sparing effect was 10–15 mg weekly (cumulative dose range 15–600 mg, median 135 mg). Methotrexate was well tolerated. Conclusions Methotrexate may be a useful treatment for steroid‐dependent chronic urticaria. Functional autoantibodies do not correlate with response. The beneficial effects of methotrexate may be anti‐inflammatory and immunosuppressive. It may therefore benefit chronic urticaria independently of the pathogenic mechanism, whether autoimmune or not.     

慢性荨麻疹患者病情严重程度与免疫五项的相关性分析

目的:分析慢性荨麻疹患者病情严重程度与血清免疫五项的相关性。方法:对160例慢性荨麻疹患者进行荨麻疹活动度评分(Urticaria Activity Score,UAS)和皮肤病生活质量评分(Dermatology Life Quality Index,DLQI),判断患者病情严重程度并分别检测其血清免疫五项指标。80例正常对照组的血清免疫五项指标作对照。对临床病情严重程度和检验结果的相关性进行了分析。结果:慢性荨麻疹患者血清IgA,C3、C4均显著低于正常对照组(P0.05);IgM高于正常对照组,差异无统计学意义(P0.05);IgG显著高于正常对照组(P0.05)。CU患者UAS评分与血清C3/C4浓度呈负相关(P0.05),与血清IgA、IgM和IgG浓度不相关(P0.05);生活质量评分与血清IgA、IgM、IgG、C3、C4浓度无显著相关性(P0.05)。结论:血清IgA、IgG、C3、C4浓度与慢性荨麻疹发病有关,其中血清C3/C4浓度或可成为慢性荨麻疹病情严重程度的评估指标。     

慢性自发性荨麻疹与25-羟维生素D水平相关性研究

目的:评估慢性自发性荨麻疹(chronic spontaneous urticaria, CSU)患者病情与25-羟维生素D水平的关系,观察补充维生素D对疗效的影响。方法:检测48例CSU患者和30例正常对照25-羟维生素D水平,研究其与CSU病情程度的相关性,将25-羟维生素D缺乏的CSU患者随机分为治疗A组和B组,A组予枸地氯雷他定、富马酸酮替芬及碳酸钙D3颗粒,B组仅口服枸地氯雷他定和富马酸酮替芬,6周后评价有效率,治疗终结2个月后比较复发率。结果:治疗前CSU组和正常对照组分别是(17.97±8.41)μg/L和(27.99±10.47)μg/L,差异有统计学意义(t=-9.478,P=0.000)。25-羟维生素D水平与CSU病情呈负相关(r=-0.375,P=0.000)。治疗A组有效率(78.26%)高于B组(43.48%),差异有统计学意义(χ²=5.841,P<0.025)。A组的复发率(4.34%)低于B组(30.43%),差异有统计学意义(χ²=6.49,P<0.01)。结论:CSU患者的25-羟维生素D水平...     

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。     

台州市531例慢性荨麻疹过敏原检测

目的:筛选台州市531例慢性荨麻疹患者过敏原。方法:采用免疫印迹法对531例慢性荨麻疹患者进行过敏原测定。结果:吸入性过敏原阳性率为25.24%(134例),其中尘螨阳性率22.41%(119例);食人性过敏原阳性率为29.0%(154例),其中蟹抗体阳性率13.75%(73例)。结论:本地区常见过敏原为尘螨。