中华皮肤科杂志 ›› 2012, Vol. 45 ›› Issue (1): 5-8.

• 论著 • 上一篇    下一篇

自体血清皮肤试验对诊断慢性荨麻疹的临床意义

何晓蕾,雷铁池,刘小明,范智峰,史赢   

  1. 武汉大学人民医院
  • 收稿日期:2011-04-06 修回日期:2011-08-08 出版日期:2012-01-15 发布日期:2011-12-31
  • 通讯作者: 雷铁池 E-mail:tiechilei@gmail.com

Clinical significance of autologous serum skin test（ASST） in the diagnosis of chronic urticaria

  • Received:2011-04-06 Revised:2011-08-08 Online:2012-01-15 Published:2011-12-31
  • Contact: Tie-Chi LEI E-mail:tiechilei@gmail.com

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摘要：

目的 探讨慢性荨麻疹自体血清皮肤试验（ASST）的不同红斑风团反应读出结果与患者血清激发嗜碱粒细胞组胺释放和血清IgG型抗高亲和力IgE Fc受体α链（抗Fc?着RI）自身抗体含量的关系。方法 60例患者均符合慢性荨麻疹的诊断标准，ASST试验阳性结果判定参照Sabroe报告的标准，又依据红斑风团反应不同，进一步将Sabroe标准ASST阳性分为风团 + 红斑模式和单纯风团模式，将Sabroe标准ASST阴性分为单纯红斑模式与无反应模式。采用酶联免疫吸附试验（ELISA）对患者血清激发正常人外周血嗜碱粒细胞组胺释放能力和血清中抗Fc?着RI自身抗体含量进行测定。结果 60例慢性荨麻疹患者ASST测试阳性19例（31.7%），其中表现风团 + 红斑模式16例和风团模式3例；ASST阴性41例，其中无反应模式38例和红斑模式3例。慢性荨麻疹患者ASST阳性血清刺激嗜碱粒细胞组胺释放率（33.83% ± 9.83%）较ASST阴性血清（4.06% ± 1.44%）显著升高（t = 5.13，P < 0.01），且几乎是10 μmol/L趋化三肽（18.67% ± 1.77%）的2倍。仅ASST阳性（风团和红斑模式）的血清能检出高滴度的抗Fc?着RI自身抗体（757.64 ± 168.99 ng/L），正常对照血清自身抗体含量仅为43.25 ± 16.63 ng/L。结论 ASST阳性（风团和红斑模式）提示血清中含有高滴度的抗Fc?着RI自身抗体，可考虑自身免疫性慢性荨麻疹的临床诊断。

关键词: 诊断

Abstract:

Objective To assess the relationships among the autologous serum-induced skin wheal-and-flare reaction, ex vivo serum-induced basophil histamine release, and serum levels of IgG anti-Fc RI autoantibodies in patients with chronic idiopathic urticaria （CIU）. Methods Sixty patients with CIU collected from the Renmin Hospital of Wuhan University were recruited for this study. Sera were obtained from the subjects, and ASST was performed in all of the subjects. The results of ASST were determined according to a recommended criterion described by Sabroe et al, and the positive results were further subclassified into wheal plus flare （W+F） pattern and wheal-only （W） pattern, negative results into flare-only （F） pattern and no response pattern. Enzyme linked immunosorbent assay was used to quantify the content of histamine released by autologous serum-induced basophils and serum levels of IgG anti-Fc RI autoantibodies. Results Of the 60 patients, 19（31.7%）were positive for ASST, including 16 （84.2%） presenting W+F pattern and 3 presenting W pattern; 41 were negative for ASST, including 3 （7.3%） giving F pattern and 38 giving no response pattern. The histamine release rate was significantly higher in ASST-positive patients than in ASST-negative patients （33.38% ± 9.83% vs. 4.06% ± 1.44%, t = 5.13, P < 0.01）, and was nearly twice as high as that in basophils induced by 10 μmol/L formyl-methionyleucylphenylalanine (Fmlp）. The serum levels of IgG anti-Fc RI autoantibodies were high in only patients giving （W+F） pattern （757.64 ± 168.99 ng/L）, but low in the normal human controls （43.25 ± 16.63 ng/L）. Conclusions The positive ASST result of wheal plus flare pattern is associated with high serum levels of IgG anti-Fc RI autoantibodies, and is suggestive of a clinical diagnosis of autoimmune chronic urticaria （ACU）.

Key words: diagnosis