Evaluation of serum levels of C-reactive protein,D-Dimer and Autologous Serum Skin Test in patients with Chronic Spontaneous Urticaria in a Brazilian tertiary center : a cross-sectional study

BackgroundThe pathophysiology of urticaria is still poorly understood. Recent studies demonstrate that the activation of coagulation is correlated with the clinical activity of Chronic Spontaneous Urticaria. Coagulation and inflammation are strongly linked.ObjectivesTo correlate the severity and activity of Chronic Spontaneous Urticaria with the levels of D-dimer, C-reactive protein, and autologous serum test in patients with Chronic Spontaneous Urticaria.MethodsThe study included 55 patients diagnosed with chronic spontaneous urticaria. D-dimer levels were measured using enzyme-linked fluorescent assay and C-reactive protein levels were measured using the nephelometric method; autologous serum testing was performed on patients who discontinued antihistamine therapy. The severity of the disease was assessed using the urticaria activity score.Resultspatients with severe, spontaneous, and difficult-to-control chronic urticaria had elevated serum levels of D-dimer, as well as a positive autologous serum test. Little correlation was demonstrated between the severity of chronic spontaneous urticaria and the levels of C-reactive protein.ConclusionThe authors concluded that patients with severe Chronic Spontaneous Urticaria showed signs of activated fibrinolysis. Most patients with high clinical scores had high D-dimer values. Patients with positive results for the autologous serum test also had more severe Chronic Spontaneous Urticaria and needed more drugs to control the disease. Finally, little correlation was found between C-reactive protein levels and disease severity.Study limitationsThe main limitation was the small sample of patients. In the present patients, it was demonstrated that serum D-dimer levels and the autologous serum test can act as predictive markers of severity and activity of Chronic Spontaneous Urticaria.     

Dermatoscopic findings of urticaria pigmentosa

Mastocytosis is a rare disease characterized by proliferation and accumulation ofmast cells in various organs. The maculopapular cutaneus mastocytosis is divided intothree subtypes: papular/plaque variant, urticaria pigmentosa and eruptive maculartelangiectasia perstans. Dermoscopic may help to better characterize the differentforms of cutaneus mastocytosis. We report a 55 year-old female with urticariapigmentosa and its dermoscopy.     

慢性荨麻疹患者血清ECP水平的测定

用法玛西亚CAPECP荧光酶标法测定30例慢性荨麻疹患者和20名正常人血清嗜酸细胞阳离子蛋白(ECP)水平。结果 ,慢性荨麻疹患者血清ECP值为25.76±2.45μg/L,正常对照组为3.3±0.74μg/L。患者组明显高于正常组(P<0.01)。因此 ,在荨麻疹的发病过程中 ,ECP可能起着一定的作用。     

Chronic urticaria in adults: state-of-the-art in the new millennium

Chronic urticaria has been explored in several investigative aspects in the newmillennium, either as to its pathogenesis, its stand as an autoimmune orauto-reactive disease, the correlation with HLA-linked genetic factors, especiallywith class II or its interrelation with the coagulation and fibrinolysis systems. Newsecond-generation antihistamines, which act as good symptomatic drugs, emerged andwere commercialized over the last decade. Old and new drugs that may interfere withthe pathophysiology of the disease, such as cyclosporine and omalizumab have beendeveloped and used as treatments. The purpose of this article is to describe thecurrent state of knowledge on aspects of chronic urticaria such as, pathophysiology,diagnosis and the current therapeutic approach proposed in the literature.     

慢性自发性荨麻疹患者血清维生素D与基质金属蛋白酶9的检测

目的 探讨慢性自发性荨麻疹患者血清25羟维生素D［25（OH）D］与基质金属蛋白酶9（MMP?9）的水平及意义。方法 用高效液相色谱?串联质谱法检测56例慢性自发性荨麻疹患者和25例健康对照血清25（OH）D水平,用酶联免疫吸附试验检测血清MMP?9水平。采用独立样本t检验或秩和检验分析两组间指标水平的差异,Spearman秩相关分析评估各检测指标之间的相关性及其与病情的关系。结果 患者组中轻度19例,中度26例,重度11例。患者组血清25（OH）D水平为（21.74 ± 6.04） μg/L,健康对照组为（30.17 ± 2.21） μg/L;患者组MMP?9水平中位数（P25 ~ P75）为291.55（166.18,594.46） μg/L,健康对照组为138.46（94.27,233.12） μg/L,两组间25（OH）D、MMP?9水平差异均有统计学意义（P < 0.05）。患者组血清25（OH）D与MMP?9水平呈负相关（rs = -0.26,P < 0.05）,MMP?9水平与症状严重程度呈正相关（rs = 0.27,P < 0.05）,25（OH）D水平与症状严重程度无明显相关关系（rs = -0.20,P > 0.05）。结论 维生素D、MMP?9在慢性自发性荨麻疹的发病过程中起一定作用。     

慢性自发性荨麻疹患者血清白细胞介素9、血小板活化因子水平与总IgE、病情严重程度和病程的相关性研究

【摘要】 目的 探讨慢性自发性荨麻疹（CSU）患者血清白细胞介素（IL）9、血小板活化因子（PAF）水平与血清IgE水平、病情严重程度和病程的相关性。方法 收集河北北方学院附属第一医院皮肤科2018年3月至2019年3月收治的60例活动期CSU,按7日荨麻疹活动评分（UAS7）将其分为轻度组、中度组和重度组;同时将经规范抗组胺治疗28 d后进入疾病静止期的患者纳入CSU静止期组。另选同期30例健康体检者为健康对照。采集各组受试者外周静脉血,使用酶联免疫法检测血清IL-9、PAF水平,选用免疫散射比浊法测定血清总IgE水平。分析CSU患者血清IL-9、PAF水平与血清总IgE水平、UAS7评分和病程之间的相关性。多组间比较采用单因素方差分析,组间两两比较采用LSD-t检验,相关性分析采用Pearson检验。结果 CSU活动期组男28例,女32例,年龄11 ~ 68（34.68 ± 8.62）岁,病程2个月至7年［（1.42 ± 0.41）年］。健康对照组男14例,女16例,年龄10 ~ 70（35.06 ± 7.89）岁。轻、中、重度CSU患者分别有12、26、22例,经规范治疗后22例纳入静止期组。CSU活动期组、CSU静止期组、健康对照组血清IL-9水平（144.34 ± 23.19、109.25 ± 20.77、107.23 ± 19.23 pg/ml）、PAF水平（362.45 ± 51.45、223.18 ± 32.46、221.23 ± 28.38 pg/ml）、总IgE水平（168.12 ± 32.48、24.04 ± 7.04、21.76 ± 5.95 IU/ml）差异均有统计学意义（F = 38.80、148.38、499.12,均P < 0.001）,CSU活动期组IL-9、PAF、总IgE水平均显著高于CSU静止期组与健康对照组（P < 0.05）;CSU静止期组与健康对照组差异均无统计学意义（P > 0.05）。血清IL-9水平、PAF水平与血清总IgE水平、UAS7评分均呈正相关（P < 0.05）,与病程无显著相关性（P > 0.05）。结论 CSU活动期患者血清IL-9、PAF水平均随病情严重程度的增加而明显升高,且与血清总IgE水平具有密切的相关性。     

仙特敏、甲氰咪呱和潘生丁联合治疗慢性荨麻疹疗效观察

报道仙特敏、甲氰咪呱和潘生丁联合应用治疗５７例慢性荨麻疹的疗效观察。结果：联合组显效率和总有效率分别为７９％和９１．２％，仙特敏单用组显效率和总有效率分别为５１．４％和７７．１％，两组比较有显著性差异（Ｐ＜０．００１）。本文提示这三种药联用是治疗慢性荨麻疹安全和有效的方法。     

Cutaneous lesions and finger clubbing uncovering hypocomplementemic urticarial vasculitis and hepatitis C with mixed cryoglobulinemia

Urticarial vasculitis is a rare clinicopathologic entity characterized by urticariallesions that persist for more than 24 hours and histologic features ofleukocytoclastic vasculitis. Patients can be divided into normocomplementemic orhypocomplementemic. The authors report the case of a healthy 49-year-old woman with a1-year history of highly pruritic generalized cutaneous lesions and finger clubbing.Laboratory tests together with histopathologic examination allowed the diagnosis ofhypocomplementemic urticarial vasculitis, chronic hepatitis C and type II mixedcryoglobulinemia. The patient started symptomatic treatment and was referred to agastroenterologist for management of the hepatitis C, with progressive improvement ofthe skin condition. The development of hypocomplementemic urticarial vasculitis inthe context of chronic hepatitis C is exceedingly rare and possible pathogenicmechanisms are discussed.     

慢性荨麻疹患者血清25羟基维生素D水平检测及意义

目的 检测慢性荨麻疹患者血清25羟基维生素D水平,探讨25羟基维生素D（25HVD）在慢性荨麻疹（CU）发病中的作用。方法 收集50例CU患者及40例健康对照血清,同时应用CU症状评分标准（UAS）对疾病进行评分;用 ELISA测定血清25HVD、干扰素γ（IFN?γ）、白细胞介素4（IL?4）、免疫球蛋白E（IgE）水平。所得数据采用t检验、秩和检验、直线相关回归分析进行统计学分析。结果 CU组血清25HVD水平［（15.20 ± 7.72） μg/L］明显低于对照组［（21.54 ± 8.31） μg/L,t = 3.75,P < 0.05］,且两组25HVD水平分布比较,差异有统计学意义（H = 17.9,P < 0.05）。UAS评分重度组25HVD水平［（15.57 ± 7.38） μg/L］与轻度组［（14.86 ± 6.28） μg/L］差异无统计学意义（t = 0.37,P > 0.05）。CU组血清IFN?γ水平明显低于对照组（t = 15.34, P < 0.05）,但血清IL?4和IgE水平明显高于对照组（t值分别为6.54, 4.88,均P < 0.05）。CU组血清25HVD水平与IFN?γ水平呈正相关（r = 0.738,P < 0.05）,与IL?4水平呈负相关（r = -0.689,P < 0.05）,与IgE水平无相关性（r = -0.271,P > 0.05）。结论 CU患者血清25HVD水平明显降低,可能通过介导Th1细胞/Th2细胞失衡参与CU的发生。     

慢性荨麻疹患者血清抗幽门螺杆菌抗体的检测及意义

为探讨幽门螺杆菌感染在慢性荨麻疹中的作用，作者采用间接ＥＬＩＳＡ技术检测了２６例生荨麻疹患者的血清抗Ｈｐ抗体。结果显示：２６例慢性荨麻疹患者中有１７例血清抗Ｈｐ ＩｇＧ抗体阳性，应用根除Ｈｐ感染的方案治疗２月后，１７例阳性患者有１２例获得痊愈。由此考虑Ｈｐ感染可能与部分荨麻疹的发生有关。     

慢性荨麻疹患者粉尘螨变应原皮肤点刺反应与自体血清皮肤反应的关系

目的 探讨自体血清的自身反应和粉尘螨诱发的变态反应在慢性荨麻疹（CU）发病中的作用和相关性。方法 对831例CU患者同时进行自体血清皮肤试验（ASST）及粉尘螨皮肤点刺实验（SPT）,对ASST与粉尘螨变应原阳性之间的相关性进行分析。结果 831例CU患者ASST和粉尘螨的总阳性率分别为51.74%和64.62%,ASST阳性组和阴性组粉尘螨SPT阳性率分别为56.52%和73.86%,两组差异有统计学意义（P < 0.05）。ASST阳性组中ASST阳性程度和粉尘螨SPT阳性程度呈负相关性（P < 0.05）。结论 自体血清皮肤反应和粉尘螨变应原诱发的变态反应均在慢性荨麻疹的发病机制中呈负相关,对CU患者同时进行变应原和ASST检测有助于临床分型和治疗。     

Enhanced serum interferon-lambda 1/interleukin-29 levels in patients with psoriasis vulgaris

BackgroundInterferon (IFN)-λ1, also named Interleukin (IL)-29, is a new member of the Type III IFN or IFN-λ family. IL-29 plays an important role in the pathogenesis of many types of autoimmune and inflammatory diseases.ObjectiveTo study the role of IL-29 in the pathogenesis of psoriasis vulgaris.MethodsThe authors detected the serum levels of IL-29 in forty-one patients with psoriasis vulgaris, twenty-three patients with atopic dermatitis and thirty-eight age and gender-matched controls by sandwich Enzyme-Linked Immunosorbent Assay (ELISA). The effects of IL-29 on the expression of cytokines, such as IL-6, IL-17, IL-8, IL-4, IL10, Interferon (IFN-γ) and Tumor Necrosis Factor-α (TNF-α), in PBMCs and HaCat cells were determined by real-time quantitative PCR.ResultsOur data indicated that serum IL-29 levels were significantly elevated in patients with psoriasis vulgaris when compared with atopic dermatitis patients and the control group. Moreover, Serum levels of IL-29 were closely associated with the severity of psoriasis vulgaris. Furthermore, IL-29 up-regulated the mRNA expression levels of IL-6, IL-17 and TNF-α in PBMCs from psoriasis vulgaris patients. In addition, IL-29 enhanced the IL-6 and IL-8 expression from the HaCat cells.ConclusionThis study provides the first observations on the association of IL-29 and psoriasis vulgaris and showed elevated IL-29 serum levels. The authors suggest that IL-29 may play a role in the pathogenesis of psoriasis vulgaris.     

荨麻疹患者血浆D二聚体、活化凝血因子Ⅶ及组织因子途径抑制物-活性凝血因子Ⅹ复合物与症状的关系

目的 探讨荨麻疹患者血浆D二聚体、活化凝血因子（FⅦa）、TFPI/Ⅹa水平与症状的关系。方法 酶联免疫吸附法检测急、慢性荨麻疹患者和健康献血者血浆D二聚体、FⅦa、TFPI/Ⅹa的水平，分析它们之间及其与症状评分、病程的关系。结果 急性荨麻疹患者的血浆D二聚体水平（450.57 ± 242.13） ng/mL高于正常人对照组（266.81 ± 40.68） ng/mL。血浆FⅦa水平（2.23 ± 0.74） ng/mL低于正常人对照组（5.23 ± 1.35） ng/mL，组间比较差异均有统计学意义（P < 0.01）。急性荨麻疹患者血浆TFPI/Ⅹa水平（0.87 ± 0.13） nmol/L与正常人对照组（0.88 ± 0.12） nmol/L比较，组间差异无统计学意义（P > 0.05）。慢性荨麻疹患者的血浆D二聚体水平（593.80 ± 294.04） ng/mL高于正常人对照组，组间比较差异有统计学意义（P < 0.01）；慢性荨麻疹患者血浆FⅦa水平（3.98 ± 0.35） ng/mL低于正常人对照组，组间比较差异有统计学意义（P < 0.01）。慢性荨麻疹患者血浆TFPI/Ⅹa水平（0.87 ± 0.16） nmol/L与正常人对照组比较，组间差异无统计学意义（P > 0.05）。急性荨麻疹患者D二聚体水平和FⅦa水平低于慢性荨麻疹患者，组间比较差异均有统计学意义（P < 0.05）。急、慢性荨麻疹患者血浆D二聚体与症状评分呈正相关关系（r = 0.68，P < 0.01；r = 0.82，P < 0.01），与病程无明显相关性（P > 0.05），FⅦa和TFPI/Ⅹa水平与症状评分关系及病程无明显相关性（P > 0.05）。结论 荨麻疹患者存在凝血系统激活和凝血因子消耗及继发性纤溶，提示D二聚体、FⅦa可能与荨麻疹症状有关。     

Urinary polyamine levels in patients with psoriasis

Summary Polyamine contents in 24 h urine of 16 psoriatic patients and seven healthy individuals are measured. The average values of putrescine and spermine showed slight increase in the psoriatic group, while those of spermidine were unchanged. When psoriatic patients are divided into three groups according to the extent of their skin lesion, the putrescine level is found to be higher in the group more serverely affected.This study was supported in part by the grant from Lydia O'Leary Foundation of Japan     

寻常性银屑病患者血清趋化因子CCL27的检测及临床意义

目的 检测寻常性银屑病患者血清CCL27水平并探讨其临床意义。方法 采用酶联免疫吸附法检测61例寻常性银屑病患者治疗前后和45例健康人血清CCL27水平。结果 61例寻常性银屑病患者血清CCL27水平为（670.02 ± 262.15） ng/L,健康人对照组为（373.10 ± 92.84） ng/L,两组差异有统计学意义（t ＝ 8.18,P ＜ 0.01）。进行期患者血清CCL27水平为（799.94 ± 214.54） ng/L,静止期为（422.57 ± 135.53） ng/L,两组差异有统计学意义（t ＝ 8.39,P ＜ 0.01）。经药物治疗8周后,银屑病患者PASI评分下降70％以上者36例,其CCL27水平明显下降,与治疗前比较,差异有统计学意义（t ＝ 9.95,P ＜ 0.01）;PASI评分下降不足70％者25例,CCL27水平与治疗前比较差异无统计学意义（t ＝ 1.84,P ＞ 0.05）。61例银屑病患者血清CCL27水平与PASI评分呈正相关（r ＝ 0.58,P ＜ 0.01）。结论 寻常性银屑病患者血清CCL27水平明显增高,并与疾病活动性相关。     

血清IL-15、IL-21、IgE水平与荨麻疹的关系

目的探讨患者血清IL-15、IL-21、IgE与荨麻疹发病机制的关系.方法用ELISA法检测急性荨麻疹(AU)、慢性荨麻疹(CU)患者及健康献血者的血清IL-15、IL-21、IgE含量,分析其与病情、病程的关系.结果AU患者血清IL-15、IL-21水平[(1.59±0.73)、(38.30±24.59)pg/mL]均低于健康对照组[(4.98±4.46)、(64.94±25.37)pg/mL],而IgE高于对照组[(91.28±41.00),(58.68±18.29)IU/mL](P＜0.01).CU患者血清IL-15、IL-21水平[(2.35±0.87)、(47.67±29.57)pg/mL]均低于对照组,而血清IgE[(76.65+38.49)IU/mL]高于对照组(P＜0.01,P＜0.05,P＜0.05).AU、CU患者之间血清IL-15、IL-21、IgE水平组间差异无统计学意义(P＞0.05).AU患者IL-15与IL-21呈正相关性(P＜0.05)、与病程呈负相关性(P＜0.05);CU患者IgE与IL-21、IL-15均呈负相关性(P＜0.01),IL-21与症状评分呈负相关性(P＜0.05).结论血清IL-21、IL-15水平下降后对IgE分泌抑制下降可能与荨麻疹发病机制有关.     

Nail involvement in adult patients with plaque-type psoriasis: prevalence and clinical features

BACKGROUND:

Psoriasis is a disease of worldwide distribution with a prevalence of 1 to 3%. Nail psoriasis is estimated in 50% of patients with psoriasis, and in the presence of joint involvement, it can reach 80%.

OBJECTIVE:

To study the nail changes - and their clinical implications - presented by patients with psoriasis vulgaris under surveillance in a university hospital from the south of Brazil.

METHODS:

his cross-sectional study evaluated 65 adult patients from January 2012 to March 2013. Cutaneous severity was assessed according to the Psoriasis Area and Severity Index (PASI). The Nail Psoriasis Severity Index (NAPSI) was used to evaluate patient''s nails. The diagnosis of psoriatic arthritis was established according to the Classification Criteria for Psoriatic Arthritis (CASPAR).

RESULTS:

The prevalence of NP was 46.1%. These patients had a median [interquartilic range (IQR)] NAPSI of 1 (0-15). A total of 63.3% of patients reported aesthetic discomfort or functional impairment related to their nails. Onycholysis was the most common feature (80%). When compared with patients without nail involvement, patients with NP had lower mean age at psoriasis onset [21 (18-41) vs. 43 (30-56) years, p=0,001]; longer disease duration [15.5 (10-24) vs. 6 (2-12) years, p=0.001]; higher PASI [9.2 (5-17) vs. 3.7 (2-10), p=0.044], higher frequency of psoriatic arthritis (43.3 vs. 3.7, p = 0.002) and more often reported family history of psoriasis (40% vs. 7.4%, p = 0.011).

CONCLUSION:

Onycholysis was the most frequent finding and most patients feel uncomfortable with the psoriatic nail changes that they experience.     

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。