金黄色葡萄球菌超抗原与特应性皮炎及湿疹关系的初步探讨

A study on superantigen production by staphylococcus aureus colonizing in skin lesion and its clinical significance in the patients with atopic dermatitis and eczema

目的:探讨皮损部位金黄色葡萄球菌(金葡菌)超抗原(SAg)与特应性皮炎(AD)及湿疹(EC)的关系。方法:反向被动乳胶凝集法测定来自91例AD和174例EC患者皮损共123株金葡菌SAg的产生情况,结合患者的严重度指数(EASI)评分、6种不同皮疹的评分以及血清学指标进行分析。结果:AD组皮损处SAg总阳性率(55.4%)及中毒休克综合征毒素(TSST)-1阳性率(21.4%)均高于EC组(37.3%、4.5%)。AD组内金葡菌肠毒素B(SEB)阳性组EASI评分高于SEB阴性组和金葡菌阴性组。EC组SAg产生与EASI评分无关,但SAg阳性组其皲裂评分较高。AD患者血清白介素(IL)-4、γ干扰素(IFN-γ)及总IgE水平与SAg无关,EC患者SAg阳性组血清总IgE水平高于金葡菌阴性组,IL-4和IFN-γ水平与SAg无关。结论:与EC相比,AD与金葡菌SAg的关系更为密切,某些型别SAg分型与AD临床严重度可能有一定联系。

Objective: To explore the correlation among superantigen (SAgs) production by colonizing in the skin lesionStaphylococcus aureus (S. aureus) and clinical severity, serum level of IgE, IL- 4 and IFN-γin patients with atopic dermati-tis(AD) and eczema(EC). Methods: One hundred and twenty three S. aureus strains were isolated from the skin lesions in 91AD and 174 EC. SAg production was detected by reverse passive latex agglutination assay. Correlation analysis was carriedout through measurement of eczema area and severity index (EASI), scores of six kinds of skin lesions and serum levels ofsome cytokines. Results: The positive rates of lesional SAgs and toxic shock syndrome toxin- 1(TSST- 1) were higher in thestrains from AD than those from EC. AD patients with staphylococcal enterotoxin B (SEB)- secreting S. aureus had a higherEASI than those without SEB-secreting S. aureus and without S. aureus colonizing in the skin. The severity of the disease wasnot related with SAgs production in EC, but the patients with positive SAg had a higher fissure score. The serum levels oftotal IgE, IL- 4 and IFN-γof AD patients were not correlated with SAg. The total IgE levels of EC patients colonized withSAg-secreting S. aureus were higher than those without S. aureus colonized, the serum levels of IL-4 and IFN-γwere not relatedwith SAg. Conclusions: SAgs production by skin- colonizing S. aureus possibly play a more important role in AD than EC.Some SAgs possibly has some relationship with clinical severity in AD.