丘疹性荨麻疹病因学系统评价

The etiology of papular urticaria: a systematic review

目的明确丘疹性荨麻疹的病因为单纯性节肢动物等昆虫叮咬所致(单因说),还是也可因食物过敏、消化功能紊乱及感染等引起(多因说)。方法应用计算机和人工检索国内外与丘疹性荨麻疹病因学研究有关的文献,按照循证医学系统评价方法分析支持单因说或支持多因说的证据。结果自 1952年以来病因学研究的22篇外文文献均支持昆虫叮咬是该病的原因,纳入的9篇中文文献中有7篇支持昆虫叮咬为致病因素,提到其他病因的另2篇文献的可信度存在疑问。从流行病学、组织病理、实验及临床研究证据均支持昆虫叮咬过敏的单因说,未发现其他原因致病的确凿证据。结论丘疹性荨麻疹可能是由于昆虫叮咬引起的过敏所致,其他假说尚缺乏充分依据。

Objective To investigate the etiology of papular urticaria： is it caused only by arthropod-like insects-bite allergy, or by multiple factors such as food allergy, disturbance of gastrointestinal function and infection？ Methods We searched, by computer and manually, the foreign and domestic literature related to the etiology of papular urticaria published since 1950s, and according to the methods of evidence-based medicine, systematically evaluated the evidence supporting either the insect-bite theory or the multiple factor theory. Results Twenty-nine articles （ 22 English and 7 Chinese ） supported the theory of hypersensitivity to bites from certain insects such as mosquitoes, gnats, fleas, mites, bedbugs etc. Two articles in Chinese mentioned the possibilities other than insect-bite, but the reliability was unconvincing, because the authors did not present the source of data or statistical methods used in the articles. The evidence from epidemiology, histopathology, laboratory and clinical researches all supported the insects-bite theory. No proven evidence was found supporting other aetiological hypotheses. Conclusion Our results suggest that papular urticaria is caused only by the allergy to stings or bites of arthropods, and other hypotheses still lack convincing evidence.