自体血清皮肤试验阳性与阴性慢性荨麻疹患者临床特点分析

目的 探讨自体血清皮肤试验阳性的慢性荨麻疹患者的临床特点。方法 从82例慢性荨麻疹患者中筛选出29例自体血清皮肤试验阳性患者,对其症状体征及病史等进行分析,并用放免法测定其血清中的抗甲状腺球蛋白抗体(TG-AB)和抗甲状腺微粒体抗体(TM-AB),与自体血清皮肤试验阴性的慢性荨麻疹患者进行对比。结果 自体血清皮肤试验阳性与阴性的慢性荨麻疹患者在年龄分布、病程上差异无统计学意义(P>0.05)。两组患者症状体征评分比较,自体血清皮肤试验阳性患者皮疹发作时风团较大(P<0.05),数量较多(P<0.01),每次发作持续时间较长(P<0.05),瘙痒更剧烈(P<0.05);但风团外观较红,隆起不明显(P<0.01);而两组患者的皮疹发作频次差异无统计学意义(P>0.05)。自体血清皮肤试验阳性的慢性荨麻疹患者伴发血管神经性水肿及系统症状的比例较高,伴随其他自身免疫相关疾病和甲状腺抗体阳性的比例也明显高于自体血清皮肤试验阴性患者(P<0.05)。结论 自体血清皮肤试验阳性的慢性荨麻疹多表现为较严重的慢性荨麻疹。     

慢性自发性荨麻疹血清YKL-40的变化及其与病情的相关性

目的探讨慢性自发性荨麻疹患者血清YKL-40(人软骨糖蛋白39)的变化及其与病情的相关性。方法采用酶联免疫法检测50例慢性自发性荨麻疹患者及30名健康志愿者血清YKL-40、IL-4、IL-10、IFN-γ水平。结果慢性自发性荨麻疹患者组血清YKL-40及TH2型细胞因子IL-4、IL-10水平明显高于对照组(P0.05),TH1型细胞因子IFN-γ水平明显低于对照组(P0.05);YKL-40水平与荨麻疹症状评分正相关(r=0.43,P0.05),与病程不存在相关性(r=0.05,P0.05);自体血清皮肤试验阳性患者血清YKL-40水平明显高于阴性者(P0.05);慢性自发性荨麻疹患者组血清YKL-40的变化与IL-4变化正相关(r=0.43,P0.05),与IL-10、INF-γ不相关(r=0.16,0.10,P0.05)。结论慢性自发性荨麻疹患者外周血血清YKL-40高表达,且与病情正相关,可能参与慢性荨麻疹的发生发展。     

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     

慢性荨麻疹患者自体血清皮肤试验结果分析

目的 :探讨慢性荨麻疹患者自体血清皮肤试验的意义。方法 :对 4 0例慢性荨麻疹患者以及2 0例正常对照者、1 0例皮肤划痕症、1 0例异位性皮炎患者进行自体血清皮肤试验。结果 :4 0例慢性荨麻疹患者中 1 3例 (32 5 % )自体血清皮肤试验阳性 ,正常对照组和皮肤划痕症及异位性皮炎患者均为阴性 ,慢性荨麻疹患者的自体血清皮肤试验阳性率显著高于正常对照组及皮肤划痕症和异位性皮炎组 (P值均 <0 0 5 )。结论 :自体血清皮肤试验的测定对自身免疫性慢性荨麻疹有一定的诊断意义。     

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。     

自体血清皮肤试验在慢性特发性荨麻疹中的应用研究

目的探讨自体血清皮肤试验(autologousserumskintest,ASST)在慢性特发性荨麻疹(chronicidiopathicurticaria,CIU)中的临床应用价值,分析ASST阳性的CIU患者的临床特点。方法采用ASST,对CIU患者组185例、健康对照组20名,过敏性疾病对照组50名患者(湿疹12例,异位性皮炎9例,面部皮炎6例,人工荨麻疹11例,支气管哮喘4例,过敏性鼻炎8例),进行测定,并记录临床症状评分及病史。结果185例CIU患者中ASST阳性率为35.68%(66/185),过敏疾病对照组及健康对照组全部阴性,3组间阳性率差异有显著性(P<0.05)。按ASST阳性结果将CIU组分为ASST阳性组与ASST阴性组。ASST阳性组的组胺风团直径较其他3组大(P<0.05),ASST阳性组在年龄分布、性别、病程等方面与ASST阴性组无统计学差异,ASST阳性的CIU患者皮疹的风团数量较多(P=0.001),风团持续时间较长(P=0.003),具有甲亢病史的患者(6.48%,12/185)出现ASST阳性结果的比例较高(58.3%,7/12)。结论在CIU患者血清是否存在自身抗体的初筛检查中,自体血清皮肤试验具有临床诊断价值及特异性,ASST阳性的慢性荨麻疹患者具有较严重的临床症状。     

慢性荨麻疹患者变应原检测及自体血清试验临床分析

目的:探讨慢性荨麻疹患者变应原检测和自体血清皮肤试验的临床意义。方法:皮肤点刺试验(SPT)检测30种变应原皮试液(包括吸入性和食物性),以生理盐水作阴性对照,以组胺作阳性对照,注射于前臂屈侧,20-30分钟后观察结果。自体血清试验(ASST)以自体血清注射于一侧前臂,另一侧注射生理盐水作阴性对照,30分钟后观察结果。结果:787例慢性荨麻疹患者中SPT有550例阳性(69.89%),6种以上变应原阳性332例(42.19%),吸入组阳性516例(65.57%)明显高于食物组309例(39.26%);ASST阳性为244例(31.00%),SPT阴性组ASST阳性率明显高于SPT阳性组。结论:SPT可以帮助我们寻找引起慢性荨麻疹的相关变应原。ASST阳性表明患者血清中存在自身抗体,可以作为自身免疫性荨麻疹的筛选试验。     

慢性荨麻疹患者甲状腺自身抗体检出情况及其临床特征研究

目的 探讨伴有甲状腺自身抗体阳性的慢性荨麻疹患者临床与血清学特点.方法 2016年1-12月,杭州市第三人民医院皮肤科70例慢性荨麻疹住院患者,依据是否伴有甲状腺自身抗体进行分组.对比两组患者的荨麻疹临床表现、自身皮肤血清试验结果、住院天数、出院转归、血常规、抗体、血清总IgE和IgG.结果 70例慢性荨麻疹患者中有26例(37.1％)伴有甲状腺自身抗体阳性,44例(62.9％)甲状腺自身抗体阴性.甲状腺自身抗体阳性的慢性荨麻疹患者较甲状腺自身抗体阴性组风团更大,瘙痒更剧烈(z=4.399,P＜0.001)、持续时间更长(z=4.43,P＜0.001)、发作频率更高(z=7.362,P＜0.001)、更易伴发系统症状(x2=7.068,P＜0.05)、自身皮肤血清试验阳性率更高(x2=6.559,P＜0.05)、住院时间更长(t=3.184,P＜0.05)、出院时痊愈率更低(x2=5.524,P＜0.05)、嗜碱性粒细胞数量更低(t=3.19,P＜0.05).结论 伴有甲状腺自身抗体阳性的慢性荨麻疹患者多表现为病情较重的荨麻疹,多伴有自身皮肤血清试验阳性和嗜碱性粒细胞水平降低.     

慢性自发性荨麻疹血清IL-17的表达及其与病情的相关性研究

目的探讨慢性自发性荨麻疹(CSU)患者血清白细胞介素(IL)-17、IL-4、IL-10、干扰素(INF)-γ的表达及其与病情的相关性。方法采用酶联免疫法检测52例CSU患者及30名健康志愿者血清IL-17、IL-4、IL-10、IFN-γ水平。结果 CSU患者组血清IL-17、IL-4、IL-10水平明显高于对照组(P0.05),IFN-γ水平明显低于对照组(P0.05);IL-17水平与荨麻疹症状评分正相关(r=0.41,P0.05),与病程不存在相关性(r=0.10,P0.05);CSU患者组血清IL-17的变化与IL-4、IL-10、INF-γ的变化不存在相关性(r分别为0.13,0.08,0.11,P0.05);自体血清皮肤试验阳性患者血清IL-17水平明显高于阴性者(P0.05)。结论 CSU患者外周血血清IL-17高表达,且与症状评分正相关。     

慢性荨麻疹患者自体血清皮肤试验结果判读时间的探讨

目的:探讨慢性荨麻疹(CU)患者自体血清皮肤试验观察时间对最终结果判定的影响。方法:对进行自体血清皮肤试验的CU患者分别在试验后20 min和30 min进行局部风团的测量。结果:共收集388例患者,皮试20 min后,有147例判定为阳性,其中有7例在30 min后转为阴性;241例判定为阴性,其中有10例在30 min后转为阳性。20 min观察阳性率为37.9%,30 min时为38.7%,患者在20 min与30 min时观察的阳性率比较,差异无统计学意义(x~2=0.24,P0.05)。结论:在慢性荨麻疹自体血清皮肤试验时,缩短观察时间至20 min,对试验结果影响不大,且有利于降低患者时间成本,提高护理人员工作效率。     

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。     

The Relation of Autologous Serum Skin Test and Autologous Plasma Skin Test Result with Various Clinical and Laboratory Findings in Patients with Chronic Spontaneous Urticaria

BackgroundDespite the autologous serum skin test (ASST) and autologous plasma skin test (APST) is widely used test accessing whether a patient with chronic spontaneous urticaria (CSU) has autoreactivity or not, the clinician often encounter difficulty making correlation between the test result and clinical implications.ObjectiveThis study was aimed to find any clinical and laboratory findings related to the ASST and APST response. Agreement and correlation between the two tests was also analyzed.MethodsA retrospective study was conducted on 300 CSU patients who underwent ASST, APST. The subjects were divided into four groups according to the skin test result. Also, the degree of serum and plasma response was recorded.ResultsBoth ASST and APST positive group had shorter duration of the disease, higher incidence of at least one episode of angioedema than negative group. There were no significant differences in the positivity for autoantibodies including antinuclear, ds-DNA, and thyroid-related between the two groups. The predicted positive rate of ASST and APST according to age showed bimodal peak and decreasing pattern according to disease duration. Predicted positivity of both tests declined with increase in total immunoglobuline E (IgE) level. In the correlation study, the two tests showed high correlation coefficients.ConclusionASST and APST positivity may be related to disease duration and severity of CSU. The two tests showed a generally consistent result. Autoreactivity may be gradually lost as disease continues. We suggest the autoreactivity in CSU could arise independently from IgE mediated immune process.     

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。     

慢性自发性荨麻疹患者自体血清皮肤试验的免疫学机制及与临床特征和预后的关系

自体血清皮肤试验(ASST)在临床上常用于筛查慢性自发性荨麻疹(CSU)的免疫亚型, 但其免疫学机制、与CSU患者临床特征及预后的关系尚未明确。研究显示, ASST阳性与CSU患者免疫球蛋白G自身抗体升高、嗜酸性粒细胞和嗜碱性粒细胞计数减少、嗜碱性粒细胞CD63表达升高、循环炎症细胞因子水平变化相关, 与患者年龄、病程以及个人或家族史无关, 但可能是慢性荨麻疹病情严重程度的预测指标。ASST阳性患者可能对第二代H1抗组胺药反应不佳, 对奥马珠单抗起效缓慢, 但对环孢素和自体全血/血清注射治疗反应良好。该文综述ASST阳性患者的免疫学和临床特征, 探讨ASST阳性对不同治疗方案疗效的预测作用。     

Autologous serum skin test response in chronic spontaneous urticaria and respiratory diseases and its relationship with serum interleukin-18 level

Autologous serum skin test (ASST) is mostly used in chronic spontaneous urticaria (CSU) to show autoreactivity. Interleukin-18 (IL-18) has also been shown to be involved in autoimmune conditions. To investigate the role of autoreactivity assessed by ASST in CSU and respiratory diseases and to investigate whether this autoreactive state is related to IL-18 level or other clinical covariates. Fifty-five patients with CSU (mean age: 40.3 ± 12.3 years), 70 patients with persistent asthma (mean age: 43.7 ± 9.6 years), 21 patients with seasonal allergic rhinitis (SAR) (mean age: 35.5 ± 11.8 years) and 20 normal controls (mean age: 37.7 ± 9.8) were included. All subjects underwent a laboratory examination and skin prick test. ASST was performed and serum IL-18 levels were measured in all subjects. Positive response to ASST and serum IL-18 levels were higher in CSU patients than those with respiratory diseases (asthma and SAR) (P = 0.034 and 0.002, respectively) and normal controls (P = 0.004 and 0.031, respectively). Considering all patients, IL-18 levels were higher in patients with positive ASST (301.8 ± 194.4 vs. 241.8 ± 206.3 pg/ml, P = 0.036) than ASST negative patients. ASST response was associated with disease severity in CSU (P = 0.037) and asthma patients (P = 0.001). Multivariate analysis showed that positive response to ASST was significantly associated with diagnosis of CSU (OR: 3.13, 95% CI: 1.25–7.87) and female gender (OR: 3.98, 95% CI: 1.19–13.38). ASST response could be related with activity of the disease. A positive ASST response found in respiratory diseases patients suggests that it may occur as a result of some inflammatory events during the diseases’ process.     

Skin autoreactivity in Hashimoto's thyroiditis patients without urticaria: autologous serum skin test positivity correlation with thyroid antibodies, sonographical volume and grading

Recent studies have shown an association between anti-thyroid antibodies and autologous serum skin test (ASST) positive urticaria patients. However, a connection between thyroid and this reliable skin test for mast cell autoreactivity, ASST, has not been reported yet. We investigated ASST in patients with Hashimoto's thyroiditis (HT) without urticaria and compared the results with laboratory and sonographical findings of HT. 154 HT patients, 100 healthy volunteers without HT as a first control group and 46 patients with multinodular goitre but without autoimmune thyroid disease as a second control group underwent testing with ASST. ASST was applied to these groups according to two criteria, first as ASST(new): autologous serum red wheal response 1.5?mm bigger than negative control; second as ASST(old): serum red wheal response 5?mm bigger than negative control accepted as positive. Free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (anti-TPO) and thyroglobulin antibody (anti-Tg) levels were measured. ASST(old), ASST(new) scored positive in 51.3-60.4% of HT patients, with statistically significant differences. Thyroid volume grades were inversely proportional with ASST(old) and (new) positivity. Moderate (+) titers of anti-Tg in ASST(old) and (new) (+) cases were significantly higher than the same titers of anti-Tg in ASST(old) and (new) (-) cases. The prevalence of ASST positivity in HT patients was not affected by the following factors: gender, age at screening, laboratory measurements of thyroid function tests, anti-TPO antibodies and thyroid ultrasound (US) echogenicity. Positivity of ASST in HT has shown that there is a skin mast cell autoreactivity in HT patients independent of autoreactive chronic urticaria (ACU).