镍接触性皮炎的斑贴试验及其组织病理学特征

Patch test in contact dermatitis due to nickel exposure and its histopathological features

目的 探讨斑贴试验在金属过敏等环境与职业性皮炎中的诊断价值 ,了解镍接触性皮炎的组织病理学特征。方法 应用欧洲标准抗原系列斑贴试验检测 110例疑诊为接触性皮炎患者 ,并对 13例硫酸镍 (5 % )斑贴试验不同时段阳性反应皮肤进行活检。结果 3 9例接触性皮炎患者对硫酸镍敏感 (占 3 5 5 % ) ,其中阳性反应皮肤组织学特征为 :2 4h时表皮轻度海绵变性和灶状空泡变性 ,少许嗜酸性粒细胞外渗 ;48～ 72h时表皮和真皮炎症达高峰 ,主要是CD45RO+ T细胞和CD68+ 巨噬细胞分布于炎症表皮及真皮血管周围。 96h～ 5d时表皮轻度增生 ,不同细胞成分参与修复过程。结论 硫酸镍是引起湿疹皮炎类疾病的主要接触变应原 ,镍皮炎病理学改变符合变应性接触性皮炎的特征。

Objective To evaluate the diagnostic value of patch test in environmental and occupational dermatitis caused by metal sensitivity,and to understand histopathological features of contact dermatitis due to nickel exposure.Method Totally,110 patients with suspected contact dermatitis were patch tested by European standard series of allergens in Zhuhai,Guangdong,China.Biopsies of the positive reaction sites of the skin were performed at varied stages of the patch test with 5% nickel sulfate in 13 of them.Result Sensitive reactions to 5% nickel sulfate were found in 39 patients(35.5%)with contact dermatitis.Histopathological studies on the patients with positive reactions showed slight spongiosis and focal vacuolation in the reaction sites of the skin at 24 h after patch test,as well as slight exocytosis of eosinophils.Inflammation in both the epidermis and dermis of the reaction sites reached the peak at 48 h to 72 h,mainly with CD45RO + T cells and CD68 + macrophages infiltration around epidermis or superficial dermal vessels.Slight acanthosis with a variety of cellular components were involved in the recovery stage at 96 h to 5 d.Conclusion Nickel sulfate is the major contact allergen in eczema or dermatitis,and histopathological features of nickel dermatitis are similar to common allergic contact dermatitis.