儿童急、慢性荨麻疹IgE及嗜酸性粒细胞检测分析

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蔡德丰, 陆元善, 袁艳, 杨晓林, 吴跃平, 马东礼. 儿童急、慢性荨麻疹IgE及嗜酸性粒细胞检测分析. 29(11): 1120-1123
CAI Defeng, LU Yuanshan, YUAN Yan, YANG Xiaolin, WU Yueping, MA Dongli. The analysis of IgE and eosinophil determinations in acute and chronic urticaria children. Labratory Medicine, 29(11): 1120-1123 复制到剪切板

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儿童急、慢性荨麻疹IgE及嗜酸性粒细胞检测分析

蔡德丰¹, 陆元善², 袁艳¹, 杨晓林¹, 吴跃平¹, 马东礼¹

1.深圳市儿童医院检验科,广东深圳 518026

2.上海交通大学附属第一人民医院输血科,上海 200080

作者简介:蔡德丰,男,1979年生,硕士,主管技师,主要从事临床检验诊断研究。

摘要

目的

探讨儿童急、慢性荨麻疹IgE水平和嗜酸性粒细胞变化及其临床意义。

方法

分别用化学发光法、酶免荧光法和VCS(体积、电导性和散射)原理检测77例急性和46例慢性荨麻疹患儿血清总IgE水平,食物、螨虫及植物类特异性IgE和嗜酸性粒细胞比例,比较急、慢性荨麻疹患儿间上述指标的差异。

结果

伴有其它过敏性疾病的急、慢性荨麻疹患儿间血清总IgE水平,食物、螨虫及植物类特异性IgE阳性率差异无统计学意义(P>0.05),但不伴有其它过敏性疾病的慢性荨麻疹患儿总IgE水平显著高于急性荨麻疹患儿(P<0.05);男性血清IgE水平显著高于女性;随着年龄增长,总IgE水平呈一定的增长趋势;螨虫类IgE阳性率显著高于食物及植物类(P<0.05)。急、慢性荨麻疹患儿嗜酸性粒细胞升高率差异无统计学意义(P>0.05)。

结论

嗜酸性粒细胞比例不能作为儿童急、慢性荨麻疹鉴别诊断的指标。IgE在无其它过敏性疾病的儿童急、慢性荨麻疹的鉴别诊断中具有一定的价值,但在其它情况,血清总IgE水平不能作为儿童急、慢性荨麻疹鉴别诊断的指标,必须结合患儿病史、病程及临床症状方能作出正确的诊断。

关键词: 免疫球蛋白; 嗜酸性粒细胞; 荨麻疹; 儿童

中图分类号:R446.62 文献标志码:A 文章编号:1673-8640(2014)11-1120-04

The analysis of IgE and eosinophil determinations in acute and chronic urticaria children

CAI Defeng¹, LU Yuanshan², YUAN Yan¹, YANG Xiaolin¹, WU Yueping¹, MA Dongli¹

1.Department of Clinical Laboratory, Shenzhen Children's Hospital, Guangdong Shenzhen 518026, China

2. Department of Transfusion, the First People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200080, China

Abstract

Objective

To investigate IgE levels, eosinophil change and their clinical significance in acute and chronic urticaria children.

Methods

Respectively by chemiluminescence, enzyme-linked immunofluorescence and volume, conductivity and scattering (VCS) principle, serum total IgE levels, food, mites and plant-specific IgE levels and eosinophil percentages were determined, and the samples were collected from 77 acute and 46 chronic urticaria children. The differences between acute and chronic urticaria children were analyzed comparatively.

Results

There was no statistical significance in total IgE levels and positive rates to food, mites and plant-specific IgE levels between acute and chronic urticaria children with other allergic diseases(P>0.05), but there was a significantly higher total IgE level in chronic group than that in acute group in acute and chronic urticaria children without other allergic diseases (P<0.05). Boys had significantly higher serum total IgE levels than girls. The total IgE levels had a trend of increasing with age. There was a higher positive rate to mites-specific IgE than food and plant-specific IgE(P<0.05). The eosinophil percentages of acute and chronic urticaria children had no statistical significance (P>0.05).

Conclusions

Eosinophil percentage is not a good index for differential diagnosis in acute and chronic urticaria children. IgE has a certain significance for diagnosing acute and chronic urticaria without other allergic diseases. However, in other cases, serum level of total IgE is not a good index for differential diagnosis in acute and chronic urticaria children. Integrating case history, course of disease and clinical symptom can help with making a correct diagnosis.

Keyword: Immunoglobulin; Eosinophil; Urticaria; Child

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引言

荨麻疹(urticaria)是一种常见的过敏性皮肤病,人群的患病率为15%25%^{[ 1, 2]}。荨麻疹临床上分为急性荨麻疹和慢性荨麻疹,急性荨麻疹被认为风疹团症状周期<6周,>6周则被认为是慢性荨麻疹^{[ 3]}。有研究表明,荨麻疹是一种复杂的病理生理现象,临床特征呈现多样性,治疗的反应性也不相同^{[ 4]}。目前对急、慢性荨麻疹的发病机制还没有确切的报道,IgE介导的肥大细胞活化被认为是急性荨麻疹主要的免疫途径;在慢性荨麻疹中自身免疫尤为明显,如Greaves研究表明慢性荨麻疹中IgG抗体与IgE受体α链(FcεRIa)有较高的亲和性。国内外对荨麻疹病程和IgE水平关系研究的报道还较少。嗜酸性粒细胞对变态反应有双向调节作用,它参与变态反应并限制嗜碱性粒细胞和肥大细胞等在速发型超敏反应中的作用^{[ 5]},尽管有较多文献报道嗜酸性粒细胞与荨麻疹的关系,但对于IgE水平及嗜酸性粒细胞与儿童荨麻疹病程的研究还较少。本研究通过对比急、慢性荨麻疹患儿IgE水平及嗜酸性粒细胞比例,分析上述指标在急、慢性荨麻疹鉴别诊断中的作用。

材料和方法

一、病例及实验设计

选取2012至2013年深圳市儿童医院诊断为过敏性荨麻疹患儿123例,年龄1~15岁,排除患儿患有其它疾病,分为急性荨麻疹组77例及慢性荨麻疹组46例,根据文献急性荨麻疹定义皮肤损伤周期<6周,慢性荨麻疹皮肤损伤延续或间歇性发作周期>6周^{[ 3]}。同时比较两组患儿血清总IgE水平,特异性食物、尘螨及植物类IgE水平及嗜酸性粒细胞变化的差异。

二、总IgE、特异性IgE及嗜酸性粒细胞检测

留取研究对象静脉血3~5 mL,离心后分离血清,血清总IgE由ADVIACen taurXP系统检测(化学发光法),检测限为0~3 000 kU/L;血清特异性IgE由ImmunoCAP250全自动免疫分析仪检测(酶免荧光法),检测限为0~100 kU/L,阳性特异性IgE>0.7 kU/L(2级以上)纳入本次研究;嗜酸性粒细胞检测由SYSMEX XS-800i五分类血液分析仪完成。

三、统计学方法

采用SPSS 17.0统计学分析系统进行分析,急、慢性荨麻疹患儿总IgE采用Student's t检验进行比较;特异性IgE敏感率及嗜酸性粒细胞比率采用 χ²检验进行比较,以 P<0.05为差异具有统计学意义。

结果

一、急、慢性荨麻疹患儿年龄及性别分布

在123例研究对象(77例急性荨麻疹和46例慢性荨麻疹)中,急性荨麻疹患儿年龄(6.09±3.69)岁,慢性荨麻疹患儿年龄(9.98±4.56)岁,两组年龄及性别分布情况见表1。急、慢性荨麻疹组纳入研究患儿男女比例相当,两组患有其它过敏性疾病史(过敏性鼻炎、哮喘、变应性皮炎)的人数及比例较为接近,分别为31例(40.26%)和18例(39.13%),且以过敏性鼻炎最为常见。

表1 急、慢性荨麻疹患儿总IgE水平

二、急、慢性荨麻疹患儿总IgE水平

急、慢性荨麻疹患儿总IgE水平分布见图1,急、慢性荨麻疹患儿IgE水平在0~200 kU/L的比率分别为71%和54%;IgE水平>500 kU/L的比率分别为15%和26%;IgE水平>1 000 kU/L的比率分别为7%和11%。提示慢性荨麻疹患儿总IgE高水平比例较高。表1显示,急、慢性荨麻疹患儿总IgE水平间差异无统计学意义( P>0.05);在无其它过敏性疾病组中,慢性荨麻疹患儿总IgE水平显著高于急性荨麻疹患儿( P<0.05);但伴有其它过敏性疾病的急、慢性荨麻疹患儿间总IgE水平差异无统计学意义( P>0.05)。随年龄增大,IgE水平呈增高的趋势,慢性组增高明显,但差异无统计学意义。急、慢性荨麻疹男性患儿总IgE水平均显著高于女性患儿( P<0.05)。

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	图1 急、慢性荨麻疹患儿总IgE水平浓度分布图

三、食物类、螨虫类、植物类特异性变应原阳性率及嗜酸性粒细胞升高比率的比较

急、慢性荨麻疹患儿间食物、螨虫、植物类特异性变应原阳性率差异无统计学意义( P>0.05);伴有其它过敏性疾病与无其它过敏性疾病患儿间3类特异性变应原阳性率差异无统计学意义( P>0.05)。见表2。

在急性及慢性荨麻疹组螨虫类变应原的阳性率均显著高于植物及食物类变应原的阳性率( P<0.05);食物类变应原阳性率与植物类变应原阳性率相比较,差异无统计学意义( P>0.05)。荨麻疹患儿常见食物类变应原为牛奶和鸡蛋白,螨虫类为户尘螨及粉尘螨。

77例急性荨麻疹患儿中41例(53.25%)由食物类、螨虫类及植物类变应原引起;46例慢性荨麻疹患儿中26例(56.52%)由食物类、螨虫类及植物类变应原引起。其中有些荨麻疹病例伴有1种或1种以上IgE阳性,荨麻疹阳性病例并不等于特异性IgE检测阳性例数,见表2。急、慢性荨麻疹患儿嗜酸性粒细胞升高率分别为44.2%(34/77)和47.8%(22/46),两组间差异无统计学意义( P>0.05)。

表2 急、慢性荨麻疹患儿食物、螨虫及植物类特异性IgE阳性率比较

讨论

目前有较多研究表明慢性荨麻疹总IgE水平升高,Kessel等^{[ 6]}的研究表明,总IgE水平与过敏性疾病的严重程度与持续时间相关,同时建议把IgE水平升高作为慢性荨麻疹患者血清学标志。从本研究结果亦可以看出,大多数慢性荨麻疹患儿总IgE处于较高水平。在伴有其它过敏性疾病患儿中,慢性荨麻疹患儿血清总IgE水平高于急性荨麻疹患儿,但差异无统计学意义( P>0.05);在无其他过敏性疾病组中,慢性荨麻疹患儿总IgE水平显著高于急性荨麻疹患儿( P<0.05),本研究与当前报道^{[ 6]}结果一致。

对两组病例患儿的年龄因素进行分析,随年龄增大,IgE水平呈一定的增高趋势,慢性荨麻疹组增高较为明显,急性与慢性荨麻疹患儿血清总IgE水平未随年龄增长呈显著性增高。

本研究结果显示男性患儿总IgE水平显著高于女性患儿,这与其它研究一致^{[ 7]}。由于女性自身免疫性疾病发病率较高,可能导致女性在IgE介导的过敏反应性与男性不同^{[ 8]},性别间不同的免疫反应能力表现为IgE表达的复杂性及致病作用的多样化。

通常认为诱导发生荨麻疹食入类变应原较吸入类变应原常见,同时有报道由IgE介导食物类变态反应是急性荨麻疹常见诱因^{[ 9]},但本研究结果与其不一致,从表2可以看出急、慢性荨麻疹患儿总的特异性变应原的阳性率之间并无明显差异;同时我们发现食物类及植物类变应原之间差异无统计学意义( P>0.05);尘螨类特异性IgE阳性率显著高于食物类和植物类特异性IgE( P均<0.05)的结果也提示,深圳地区尘螨是急、慢性荨麻疹发病的主要变应原,这与中国其它地区研究结果较为一致^{[ 10]}。这可能与深圳地区环境有关,深圳地区处于亚热带气候,温暖湿润,如果不加强室内通风,不经常晾晒被褥,不打扫房屋的死角,螨虫类微生物往往易于滋生。

有文献报道,嗜酸性粒细胞在荨麻疹患者中显著升高,且急性期较慢性期有明显的升高,但也有报道持相反的观点^{[ 11, 12]},这些争议反映了嗜酸性粒细胞在荨麻疹发病中的复杂性。本研究分析结果显示,急、慢性荨麻疹患儿嗜酸性粒细胞较正常儿童有明显升高,升高率分别为44.2%、47.8%;急、慢性荨麻疹间嗜酸性粒细胞升高率无显著差异,说明嗜酸性粒细胞在急、慢性荨麻疹的鉴别诊断中无特殊价值。

综上所述,荨麻疹患儿总IgE水平男性显著高于女性;在无其他过敏性疾病患儿中,慢性荨麻疹组总IgE水平显著高于急性荨麻疹组;嗜酸性粒细胞升高比率在临床鉴别诊断急、慢性荨麻疹中无特殊价值;螨虫类所致的变态反应且引起荨麻疹症状在深圳地区占主导地位,其特异性IgE阳性率显著高于食物类及植物类变应原。常规实验室检测在急、慢性荨麻疹的鉴别诊断上无特异性,目前患儿主诉、临床诊断、病程的分析仍是急、慢性荨麻疹鉴别诊断的主要方法。

The authors have declared that no competing interests exist.

参考文献

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2006

0.0

Clinic Rev Allerg Immunol. 2006, 30(1):47-51

Urticaria and quality of life

Jean-Jacques Grob (1) , Caroline Gaudy-Marqueste (1)

1.Hôpital Ste Marguerite, Université de la Méditerranée et Service de Dermatologie, Marseille, France

The common perspective of physicians on chronic urticaria (CU) refers to a benign disorder with no pain and no threat to function or life. Heath-related quality-of-life (HRQOL) tools have demonstrated the extent to which physicians underestimate the impact of this disorder. From the patient perspective, CU affects as many dimensions of the HRQOL as some life-threatening diseases or well-recognized disabling chronic skin disorders, such as psoriasis or atopic dermatitis. Pruritus as well as swelling and wheals triggered by unavoidable events, such as pressure or sweating, greatly contribute to HRQOL impairment. Recent trials have suggested that dermatology-specific HRQOL instruments could be more relevant than more objective severity scores when studying and comparing the benefit of various therapeutic strategies in chronic idiopathic urticaria.

2006

0.0

. 2006, 30(1):13-18 DOI:10.1385/CRIAI:30:1:013

Eosinophils and urticaria

1.Hospital Claude-Huriez Department of Dermatology, CHRU Lille France 2.Institut Pasteur de Lille Institut National de la Sante et de la Recherche Medicale, Unite 547, Institut Fédératif de Recherche 17 Lille France

Previously believed to have an exclusive role in the release of cytotoxic mediators in the defense against helminthic infections, eosinophils are now considered key players in inflammatory reaction and regulation of immune response. Through activation of a large variety of membrane receptors and production of various pharmacologically active mediators, eosinophils may exert a detrimental role in tissues in which they have been recruited and may contribute to the perennization of inflammatory processes. The crucial role of eosinophils has been documented in several eosinophilic skin diseases, such as hypereosinophilic syndrome and bullous pemphigoid, and the literature provides strong evidence for their role in urticaria. The aim of this article is to discuss the mechanisms of specific tissue recruitment of eosinophils, the factors of eosinophil activation, and the contribution of these cells to inflammation and immunoregulation in urticaria. Recent advances in the knowledge of eosinophils will certainly help toward developing new strategies for the management of antihistamines resistant to urticaria.

2007

3.487

0.0

... 6周则被认为是慢性荨麻疹^[3] ...

... 6周^[3] ...

2006

0.0

Clinic Rev Allerg Immunol. 2006, 30(1):3-11

Pathophysiology of urticaria

Ana Hennino (1) , Fréderic Bérard (2) , Isabelle Guillot (2) , Nathalie Saad (2) , Auore Rozières, Jean-François Nicolas (1) (2)

1.Inserm U 503 IFR 128 Biosciences Lyon-Gerland, Lyon 2.Unité Immunologie Clinique et Allergologie, Dufourt 5F, Pierre-Bénite Cedex, France

Urticaria is dermal edema resulting from vascular dilatation and leakage of fluid into the skin in response to molecules released from mast cells. The major preformed mediator histamine produces a prototypic, short-lived urticaria. However, the clinical spectrum and pattern of lesions indicate that other molecules, including prostaglandins, leukotrienes, cytokines, and chemokines, produced at different times after mast cell activation contribute to the polymorphism of this symptom and the variable evolution of this disease. It is a common practice to distinguish immunological and nonimmunological urticaria. Immunological urticaria is a hypersensitivity reaction mediated by antibodies and/or T-cells that results in mast cell activation. Although immunoglobulin (Ig)E-mediated type I hypersensitivity (HS) was long postulated to be the major immunological pathway associated with mast cell activation, interaction between IgE-bound mast cells and allergens is unlikely to be the mechanism by which urticaria develops in most patients. It is now well established that urticaria may result from the binding of IgG auto-antibodies to IgE and/or to the receptor for IgE molecules on mast cells, thus corresponding to a type II HS reaction. These auto-immune urticarias represent up to 50% of patients with chronic urticaria. Mast cell activation can also result from type III HS through the binding of circulating immune complexes to mast cell-expressing Fc receptors for IgG and IgM. Finally, under certain circumstances, T-cells can induce activation of mast cells, as well as histamine release (type IV HS). Nonimmunological urticarias result from mast cell activation through membrane receptors involved in innate immunity (e.g., complement, Toll-like, cytokine/chemokine, opioid) or by direct toxicity of xenobiotics (haptens, drugs). In conclusion, urticaria may result from different pathophysiological mechanisms that explain the great heterogeneity of clinical symptoms and the variable responses to treatment.

... 有研究表明,荨麻疹是一种复杂的病理生理现象,临床特征呈现多样性,治疗的反应性也不相同^[4] ...

2010

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... 嗜酸性粒细胞对变态反应有双向调节作用,它参与变态反应并限制嗜碱性粒细胞和肥大细胞等在速发型超敏反应中的作用^[5],尽管有较多文献报道嗜酸性粒细胞与荨麻疹的关系,但对于IgE水平及嗜酸性粒细胞与儿童荨麻疹病程的研究还较少 ...

2010

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... 讨论目前有较多研究表明慢性荨麻疹总IgE水平升高,Kessel等^[6]的研究表明,总IgE水平与过敏性疾病的严重程度与持续时间相关,同时建议把IgE水平升高作为慢性荨麻疹患者血清学标志 ...

... 05),本研究与当前报道^[6]结果一致 ...

2005

4.789

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. 2005, 35(5):619-623

Variability of total serum immunoglobulin E levels from birth to the age of 10 years. A prospective evaluation in a large birth cohort (German Multicenter Allergy Study)

R. Nickel,S. Illi,S. Lau,C. Sommerfeld,R. Bergmann,W. Kamin,J. Forster,A. Schuster,B. Niggemann,U. Wahn andthe German Multicenter Allergy Study Group (MAS-90)

Departments of *Pediatric Pneumology and Immunology†Obstetrics, Charité, Humboldt University, Berlin, Germany, ‡Department of Pediatrics, University Hospital Mainz, Germany, §Department of Pediatrics, St Hedwig Hospital, Freiburg, Germany¶Department of Pediatrics, University Hospital Düsseldorf, Germany * R. Nickel, Department of Pediatric Pneumology and Immunology, Charité, Humboldt University, Augustenburger Platz 1 D-13353, Berlin. E-mail: <a href="mailto:renate.nickel@charite.de" title="Link to email address" shape="rect">renate.nickel@charite.de</a>

Background Many environmental factors influence the concentration of total serum IgE (tIgE); however, tIgE synthesis is believed to be under strong genetic influence. Multiple genetic studies on tIgE regulation have been performed. For these population-based studies tIgE was commonly determined at one time-point, assuming that tIgE phenotypes (adjusted for age and gender) are stable over time.

... 本研究结果显示男性患儿总IgE水平显著高于女性患儿,这与其它研究一致^[7] ...

2002

0.0

. 2002, 966(1):13-19

Neuroimmunoendocrinology of the Rheumatic Diseases

RONALD L. WILDER *

Department of Clinical Development, MedImmune, Inc., Gaithersburg, Maryland, U.S.A. *Address for correspondence: Ronald L. Wilder, M.D., Ph.D., Director, Clinical Development, MedImmune, Inc., 35 W. Watkins Mill Road, Gaithersburg, MD 20878, U.S.A. Voice: 240-632-4078; fax: 240-632-4212; <a href="mailto:wilderr@medimmune.com" title="Link to email address" shape="rect">wilderr@medimmune.com</a>.

Abstract: Adaptation to stressful stimuli, maintenance of homeostasis, and ultimately, survival require bidirectional feedback communication among components of the stress response and immune and endocrine systems. Substantial progress has been made in delineating molecular, cellular, and systemic physiologic mechanisms underlying this communication, particularly mechanisms that target the immune system. For example, our understanding of the immunomodulatory activities of numerous neuroendocrine mediators, such as cortisol, estrogen, testosterone, DHEA, catecholamines, corticotropin-releasing hormone, and adenosine, has advanced substantially. Substantial progress has also been made in defining how abnormalities involving these factors may contribute to the initiation, progression, and severity of autoimmune rheumatic diseases, particularly rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). For RA, the available data support the view that inflammatory and immune system inhibitory mechanisms, involving the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system are deficient. Age, gender, and reproductive status acting, in part, through gonadal hormonal effects on disease susceptibility genes also appear likely to modulate the inhibitory stress response systems and immune function. Animal model data also have provided direct evidence that many autoimmune disease regulatory genes are gender influenced. For SLE, a growing body of recent data indicates that estrogens and androgens exert contrasting effects on B-lymphocytes (i.e., estrogens enhance and testosterone suppresses autoantibody production). These observations provide potential new insights into SLE pathogenesis and gender differences in prevalence. Continued investigation will refine our understanding of these observations and will uncover even more extensive interactions of the nervous, immune, and endocrine systems. Moreover, it is highly likely that improved understanding of these interactions will translate into improved therapy for the rheumatic diseases.

... 由于女性自身免疫性疾病发病率较高,可能导致女性在IgE介导的过敏反应性与男性不同^[8],性别间不同的免疫反应能力表现为IgE表达的复杂性及致病作用的多样化 ...

2011

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... 通常认为诱导发生荨麻疹食入类变应原较吸入类变应原常见,同时有报道由IgE介导食物类变态反应是急性荨麻疹常见诱因^[9],但本研究结果与其不一致,从表2可以看出急、慢性荨麻疹患儿总的特异性变应原的阳性率之间并无明显差异 ...

2012

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... 05)的结果也提示,深圳地区尘螨是急、慢性荨麻疹发病的主要变应原,这与中国其它地区研究结果较为一致^[10] ...

2009

1.329

0.0

. 2009, 34(5):e14-e17

Persistent urticaria characterized by recurrent lasting urticarial erythema with histological features of prominent perivascular eosinophilic infiltration

H. Amano,Y. Nagai andO. Ishikawa

Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan *Dr Hiroo Amano, Department of Dermatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371–8511, Japan. E-mail: <a href="mailto:hamano@showa.gunma%E2%80%90u.ac.jp" title="Link to email address" shape="rect">hamano@showa.gunma-u.ac.jp</a>

We report a 29-year-old woman with a 15-year history of recurrent pruritic urticarial erythemas. The individual lesions lasted for > 24 h, and antihistaminic agents were not effective. Histological examination of a skin biopsy revealed interstitial oedema of the dermis and perivascular infiltration of numerous eosinophils without vasculitis. No internal organ involvement or peripheral blood eosinophilia was present. A diagnosis of persistent urticaria was made and the patient was successfully treated with oral corticosteroid therapy. Persistent urticaria has been described as an unusual reaction that lasts longer than typical urticaria. It is effectively treated with corticosteroids, but not with antihistaminic agents. In order to choose the most effective treatment, persistent urticaria should be recognized as a different clinical condition from typical urticaria.

2009

0.0