链球菌、分支杆菌及皮肤鳞屑蛋白与银屑病关系的研究

目的 探讨β－溶血性链球菌、分支杆菌及皮肤鳞屑蛋白屑病的关系。方法 用常方法培养分离银屑病患者咽拭物。用ＥＬＩＳＡ测定银屑病患者血中抗β－溶血性链球菌超声抗原、结核分支杆菌粗脂抗原及银屑病鳞屑蛋白的相应抗体水平。结果 （１）寻常型银屑病患者咽部菌群以β－溶血性链球菌为主。（２）各型奶屑病口才因中抗β－溶血笥链球菌抗体均有不同程度的升高。其中点滴状银屑病例ＩｇＧ为主，斑块状患者以ＩｇＭ为主，与正常人     

天然抗角蛋白自身抗体与银屑病关系的实验研究

目的　探讨天然抗角蛋白自身抗体 (antikeratinautoantibody ,AKautoAb)与银屑病的关系及AKautoAb在银屑病中的作用和意义。方法　应用自银屑病患者血清和鳞屑洗脱液内纯化的AKautoAb ,在体外观察其对培养角质形成细胞DNA合成及细胞代谢的影响。结果　银屑病患者血清内可纯化出AKautoAb ,但其纯化量明显低于正常人 ,鳞屑洗脱液中亦可纯化出AKautoAb ;纯化的AKautoAb在体外能抑制角质形成细胞的代谢活性 (P <0 .0 5 )。结论　存在于银屑病患者血清和鳞屑内的AKautoAb可能是一种具有保护作用的继发性反应。     

银屑病患者血清中检出抗分枝杆菌及其有关抗原成分抗体

目的：检测银屑病患者血清中是否存在抗整分枝杆菌及其有关抗原成分的抗体。方法：用整分枝杆菌及其有关组分做怕,间接酶联免疫地试验（ＥＬＩＳＡ）检测银屑病患者和正常对照者血清中有否相关抗体的存在,进行统计学比较分析。结果：发现受检银屑病患者血清中存在很高水平的抗受试的分枝杆菌及其有关抗原组分ＬＡＭ－Ｂ的抗体,而且与相应的正常对照组间统计学上存在非常显著的差异。结论：银屑病患者血清中患者存在很高水平的抗整     

银屑病患者红细胞免疫功能的研究

目的：明确银屑病特别是该病病情波动与红细胞免疫功能变化的关系。方法：检测１２３例银屑病患者和３５例正常人Ｅ－Ｃ３ｂＲＲ、Ｅ－ＩＣＲ,对其中５８例患者４周后作随访检测。结果：（１）银屑病患者Ｅ－Ｃ３ｂＲＲ、Ｅ－ＩＣＲ均较正常人高;（２）病程５年以上级较５年以下组病人的Ｅ－Ｃ３ｂＲＲ高;（３）ＰＡＳＩ与Ｅ－Ｃ３ｂＲＲ呈正相关;（４）ＰＡＳＩ的治疗前后变化值与Ｅ－Ｃ３ｂＲＲ变化值呈正相关。结论：银屑病患者红细胞免疫功能存在亢进和紊乱。红细胞免疫粘附功能试验可作为判断银屑病病情和预后的客观指标之一。     

反向银屑病研究进展

反向银屑病又称间擦银屑病或屈侧银屑病,是银屑病的一种特殊表现类型,在中国人群中发病率占银屑病的3.2%~7%。同寻常型银屑病相比,在发病部位上,主要为体表褶皱部位;在临床表现上,表现为境界清楚的红斑,其上覆少量鳞屑或无鳞屑,炎症更明显,同形反应更敏感;在发病机制上,皮损中CD161~+表达量明显下降,与微生物定植相关;在治疗上,局限性反向银屑病以局部治疗为主,重症或伴发其他类型银屑病需系统治疗。本文就反向银屑病的流行病学、临床特征、发病机制及治疗等方面进行详细的综述。     

寻常性银屑病肾脏损伤与PASI评分的关系

目的探讨银屑病皮损面积和严重程度与银屑病肾损伤的关系。方法采用Spearman秩对114例银屑病患者进行尿Alb,尿IgG,尿β2-MG与皮肤损害面积和皮肤损伤程度进行相关分析。结果构成PASI的红斑、浸润、鳞屑、面积四项因素均与尿微球蛋白不相关,而4项因素均与尿球蛋白具有相关性,红斑、浸润、鳞屑3项因素与尿白蛋白具有相关性。结论肾小球损伤与PASI相关密切,尤其是红斑与肾小球结构性损伤相关性更为密切。     

银屑病患者白介素8含量测定

近年来国外有报道白介素８（ＩＬ８）在银屑病发病中具有一定的作用［１～４］，为此我们对银屑病患者进行了ＩＬ８含量测定，现将结果报告如下。一、资料和方法检测对象：取自１９９３年１０月至１９９４年７月我科门诊及住院的银屑病患者，共５１例，男３１例，女２０例，年龄１４～５６岁，病程７天至３８年，其中４例为脓疱型银屑病，多数病人同时进行了血清、外周血单－核细胞（ＰＢＭＣ）、表皮组织及鳞屑中ＩＬ８水平的测定。正常对照组：①血清及ＰＢＭＣ对照组２５例；②表皮组织对照组１５例为手术室切除的正常皮肤组织；③鳞屑对…     

银屑病患者血清抗EB病毒抗体的检测

目的：探讨EB病毒感染与银屑病的关系。方法：采用酶免疫法检测53例银屑病患者血清EB病毒抗壳抗原／IgG、IgM抗体，抗早期抗原－D／IgG抗体。抗核心抗原－1／IgG抗体。结果：银屑病患者血清抗ER病毒早期抗原－D／IgG抗体阳性率明显高于正常对照组（P＜0．001）。结论：银屑病患者体内EB病毒可能处于激活状态。     

生长抑素和银屑病

生长抑素和银屑病姚聪君综述王俊民审校西安医科大学第二附属医院皮肤科（邮政编码７１０００４）生长抑素（Ｓｏｍａｔｏｓｔａｔｉｎ，ＳＳ），即生长激素释放抑制激素，包括ＳＳ－１４和ＳＳ－２８及前激素。最初于１９７２年从下丘脑的提取物中分离得到。它存在于人体...     

银屑病的病因和治疗的研究进展

介绍了欧美有关银屑病的病因和治疗研究的新进展。特别是超抗原理论在银屑病中的地位颇为人们所重视。在外用药中焦油、蒽林仍在应用,皮质类固醇逐渐减少应用,而新药钙泊三醇、环孢素A的出现增加了银屑病的治疗手段。如何合理组织处理病人是防治银屑病面临需要解决的问题。     

Silencing of homeobox A5 gene in the stratum corneum of psoriasis

Analysis of psoriatic parakeratotic cells is helpful for understanding the pathogenesis of psoriasis. Methylation analysis can be performed on psoriatic scales, but it is unclear whether genes can be silenced by DNA methylation in psoriatic stratum corneum. The present study was conducted to detect genes silenced in psoriatic stratum corneum. Methylation array analysis with 485 577 probes, quantitative real‐time methylation‐specific PCR (RT‐MSP) and bisulphite sequencing were performed for 30 psoriatic scale samples, 6 fully developed psoriatic skin samples and 12 normal skin samples. Immunohistochemical staining of HOXA5 was performed for 29 psoriatic epidermal samples and 13 normal epidermal samples. The genome‐wide methylation array detected two CpG sites within CpG islands (CGIs) located in promoter regions of HOXA5 and LIAS that had methylation levels of >0.6 in at least one of the three psoriatic scale samples and of <0.2 in all three normal skin tissue samples (methylation rate range, 0.0‐1.0). RT‐MSP for HOXA5CGI, in which the primers were successfully developed, revealed that the average methylation level of 27 psoriasis scales (60.2%) is significantly higher than that of 9 normal skin samples (34.6%) (P=.013). Immunohistochemical staining revealed that HOXA5 protein was not expressed in the stratum corneum of fully developed psoriatic epidermis, but the protein was expressed in the stratum corneum of incompletely developed epidermis and normal epidermis. In conclusion, HOXA5 can be silenced in the stratum corneum of psoriasis. The silenced gene was identified by non‐invasive methylation analysis of psoriatic scales.     

Leukotactic properties of soluble substances inpsoriasis scale

In an attempt to elucidate the mechanicms underlying the production of transepidcrmal migration of leukocytes toward the stratum corneum in psoriatic lesions, the chcmotactic properties of soluble substances in psoriasis scales were examined by a modified Boydm's chamber. All crude extract of horny tissues studied, i.e. callus, scales of exfoliative dermatitis and of psoriasis vulgaris, showed chcmotactic activity for human peripheral blood leukwyta. But only the chemotactic activity of the psoriasis scale extract was highly potent. This was greatly reduced after dialysis. Fresh strum was not required to manifest thechemotactic activity. By Sephadex G-200 chromatography, the scale extracts from psoriasis vulgaris and pustular psoriasis had potent activity cluted near the cytochrome C marker. The same fractions of other horny tissue extracts, bacterial filtrate prepared from cultured psoriasis scale fragments, and serum did not show such potent activity. On the basis of analysis by gel tiltration and recent tindings of immunopathological studies, a postulate was made that a complement derived cbemotactic factor, possibly a C₅ cleavage product, developed as a result of antigen—antibody reaction in the stratum corneum of psoriatic lessions.     

Is psoriasis an autoimmunologic disease?]

DThe defective function of T-lymphocytes, which is a finding in active psoriasis, is transitional and reversible, whereas the immunological mechanism is mainly related to the formation of immune complexes consisting of stratum corneum antibodies and stratum corneum antigen, which through binding of complement and activation of chemotactic complement components is responsible for the phenomenon of "squirting papillae". The earliest lesions preceding pin point papules, called pre-pin-point papules, were induced by stripping or developed spontaneously in a marked field closely observed for several days. In the changes preceding earliest psoriatic lesions. Abundant polymorphonuclear infiltrates are present, and polymorphs seem to play an important role in a selfperpetuating of disease process. The therapeutic implications of the immunologic studies in psoriasis are: either depletion of activated polymorphs (eg. continuous peritoneal dialysis) and/or removal of the factors responsible for their activation (eg. treatment of focal infections) or external use of the drugs affecting the antigenicity of stratum corneum (tars), or inhibition of exocytosis (a probable mechanism of puva).     

Heterogeneity of fluorescence in psoriasis after application of 5-aminolaevulinic acid: an immunohistochemical study

BACKGROUND: Psoriasis has been shown to highly accumulate protoporphyrin IX (PpIX), but a variable distribution within plaques after fluorescence diagnosis is seen. It is unknown what causes this heterogeneity of fluorescence in psoriatic skin, despite adequate keratolytic treatment. Variations in fluorescence might explain the variable and the mostly partial clinical response of psoriasis seen after photodynamic therapy (PDT). OBJECTIVES: This study examines morphological and immunohistochemical differences in inhomogeneous PpIX-induced fluorescence in stable plaque psoriasis. MATERIALS AND METHODS: Fourteen patients with stable plaque psoriasis were included in this study. In each patient one psoriatic plaque was incubated with 20% 5-aminolaevulinic acid (ALA) ointment for 3 h after keratolytic treatment. Fluorescence diagnosis with ALA-induced porphyrins (FDAP) was performed and subsequently high- and low-fluorescent psoriatic skin samples were biopsied. Biopsies were investigated with respect to histological hyperkeratosis (thickness of stratum corneum), proliferation (Ki-67 antigen), keratinization (K10, filaggrin) and inflammation (CD3). Digital images acquired with FDAP were analysed using image analysis software. RESULTS: Inhomogeneous fluorescence was seen in 12 of the 14 plaques. A significantly thicker stratum corneum was found in low-fluorescent psoriatic skin compared with highly fluorescent skin. Fluorescence intensity and thickness of the stratum corneum proved to be negatively correlated. The variable-fluorescent parts of the lesional psoriatic skin showed no differences in epidermal proliferation, keratinization or inflammation. CONCLUSIONS: Heterogeneous ALA-induced fluorescence in psoriasis plaques related to inhomogeneous distribution of PpIX in the epidermis may result from differences in penetration of ALA and/or light within a plaque caused by differences in stratum corneum thickness. The variable clinical response seen after PDT in psoriasis could be explained by this. These findings are consistent with the general assumption that optimal desquamation prior to FDAP or PDT is required for the most favourable results.     

Immunologic abnormalities in psoriasis: the inhibition of leucocyte migration by stratum corneum antigens

The migration inhibition of peripheral blood leucocytes by stratum corneum (SC) antigens extracted from psoriatic scales and normal skin was studied in 25 patients with psoriasis and 12 normal controls. In 44% of patients, the radius of the area of spontaneous migration in the absence of antigen was significantly reduced. 9 out of 25 psoriatic cases showed inhibition of leucocyte migration after the addition of both SC antigens. Migration inhibition with SC antigens was observed only in patients in whom the radius of spontaneous migration area appeared to be normal. The data did not confirm the evidence of delayed hypersensitivity to epidermal SC antigens in patients with psoriasis. The decrease of spontaneous leucocyte migration in psoriasis might be dependent on the influence of antibodies against stratum corneum and/or immune complexes coated on lymphocyte or leucocyte surface membrane.     

银屑病患者血清及皮肤中补体及其活化成分的变化

目的 研究银屑病患者血清及皮肤中补体及其活化成分的变化,以探讨其与银屑病皮损形成的关系。方法 采用双抗体夹心ELISA法和免疫比浊法检测了57例银屑病患者血清补体活化片段C3d及可溶性补体激活片段sC5b-9及补体C3、C4的变化;采用免疫组化法(ABC法)检测了37例银屑病患者皮损组织、非皮损组织及20例正常皮肤组织C5b-9的原位表达。结果 银屑病患者血清中C3、C4水平明显下降;C3d、sC5b-9水平明显增高,与对照组比较差异有非常显著性,进行期患者血清中C3、C4明显低于静止期,而C3d、sC5b-9明显高于静止期,差异均有显著性。银屑病皮损组织中角质层和真表皮交界处C5b-9阳性数显著高于非皮损组织和正常组织;进行期银屑病患者皮损组织角质层和真表皮交界处C5b-9阳性表达数差异无显著性。结论 银屑病的发病以及皮损的严重程度与补体的活化可能有关。     

The keratin polypeptides of psoriatic epidermis

The polyacrylamide SDS electrophoretic pattern of protein extracted from the stratum corneum obtained by scraping the surface of involved skin of patients with psoriasis was different from that of uninvolved skin and normal controls. The pattern from superficial scales was similar to that of whole stratum corneum in the case of involved psoriatic epidermis but different in uninvolved and normal epidermis. These data indicate that the changes which are observed in the structural proteins during normal keratinization are not seen in involved psoriatic epidermis. In addition, the relative proportion of keratin polypeptides was different in involved psoriatic epidermis compared to normal skin. That these changes are not specific for psoriasis was shown by finding similar electrophoretic patterns with stratum corneum proteins from patients with other keratinizing disorders.     

Extractable immune complex in soluble substances from psoriatic scales

Summary Soluble substances of psoriatic scales (Psoexts) were analysed immunologically to detect immune complex (IC) related to the immune reactions in psoriatic lesions and compared with extracts of scales from a patient with erythroderma due to pityriasis rubra pilaris (PRP-exts) as control. Immunoelectrophoretically IgG, IgA and C3 were detected in Pso-exts, but in PRP-exts only IgG was seen as immunological reactive substances. When analysed by Sephadex G-200 column chromatography, IgG and IgA eluates were found in Pso-exts with a molecular weight of more than 200,000 daltons. By Raji cell assay, the IgG and IgA eluates were shown to have IC characteristics and they were the IC composed of IgG-IgA, which was also confirmed using anti-IgG affinity chromatography. The IC seemed to be binding the epidermal proteins as antigen. Thesefindings suggest that deposits of immunoglobulins and complement in the stratum corneum of psoriatic lesions are not just secondary to the underlying inflammation in the dermis but that the IC detected is related to the immune reactions in psoriatic lesions.     

Defective barrier function accompanied by structural changes of psoriatic stratum corneum

Although barrier function of psoriatic skin is shown to be decreased by measuring transepidermal water loss (TEWL), few reports exist examining other physical skin properties and components including stratum corneum hydration, natural moisturizing factor (NMF), free fatty acids (FFA), β‐sheet and α‐helix ratio of structural protein(s), and sebum content. We compared the skin properties and components of normal, involved and uninvolved skin of psoriasis. Using a corneometer and attenuated total reflection‐infrared spectrometer, we measured TEWL, stratum corneum hydration, NMF, FFA, β/α ratio and sebum in psoriasis vulgaris patients and healthy controls. TEWL and β/α ratio of involved psoriatic skin were significantly increased compared with uninvolved skin and normal control skin. In contrast, stratum corneum hydration , NMF and FFA, but not sebum, are significantly decreased in the involved skin compared with uninvolved skin and normal skin. TEWL and stratum corneum hydration returned to the normal levels following clinical improvement of the lesion. Barrier function and hydration of psoriatic skin are defective and secondary structure in stratum corneum protein is altered in the involved psoriatic skin.     

Hydration characteristics of pathologic stratum corneum--evaluation of bound water

We measured in vitro the hygroscopicity and bound (non-freezing) water of various samples of pathologic horny layer obtained from the lesions of senile xerotic skin and psoriasis vulgaris and the normal horny layer from glabrous skin and plantar horny layer. The amount of water taken up by pathologic stratum corneum was much smaller than that by normal horny layer in an environment at a high relative humidity (RH). Tightly bound primary water to stratum corneum measured by Karl Fischer's method was about 5 mg/100 mg of dry stratum corneum in all the samples studied, while less tightly bound secondary water was much smaller in amount in pathologic stratum corneum than in the controls, i.e., 31.7 mg/100 mg dry scale from senile xerosis and 27.2 mg/100 mg dry psoriatic scale as compared with 38.2 mg/100 mg dry normal stratum corneum from glabrous skin and 37.3 mg/100 mg dry normal plantar stratum corneum. We believe that the low hygroscopicity of the pathologic stratum corneum is due to this smaller capacity for secondary bound water, which is responsible for the development of a dry scaly appearance even at high RH.