变应性金属皮炎86例斑贴试验结果分析

Analyses of Patch Tests on 86 Cases with Metal Dermatitis

目的探讨变应性金属皮炎（metal dermatitis,MD）的常见变应原及斑贴试验（patch test,PT）的临床应用。方法分析4种金属变应原在86例PT阳性MD中的作用、PT检查与临床诊断的符合情况。结果1种金属阳性52例,2种金属阳性19例,3～4种金属阳性15例,其中镍抗原单一或合并阳性率分别为80.77%,68.42%和100.00%。86例MD患者均有明确的金属接触史及相应部位皮损,仅45例（52.33%）临床诊断为接触性皮炎。结论镍是MD最常见的金属变应原,其次为钴;合并镍过敏有助于非镍金属过敏的发生,并增大其反应强度（P〈0.01）。MD表现形式多样,47.67%病例首诊误诊;结合病史及体检,PT有助于明确变应原及指导治疗MD。

Objective To study the frequent allergen（s） inducing metal dermatitis （MD） and the application of patch tests （PT） in clinical practice. Methods The explore of four metal allergens （ MA ） on 86 cases of MD with positive PT results and the correspondence between PT investigations and clinical diagnoses were analyzed. Results 52 cases were one MA, 19 two MAs,and 15 three or four MAs involved. The nickel MA,single or concurrent,positive percentage was 80.77% ,68.42% ,and 100.00% ,respectively. Although there were definite histories of metal contact and coincidental lesions in all cases, only 45 cases （ 52.33% ） were diagnosed as contact dermatitis. Conclusion Nickel is the most frequent MA while cobalt ranks second. Concurrence with nickel sensitization may assist in developing non-nickel MAs hypersensitivity and intensifying their PT reactivity（ P 〈 0.01 ）. MD manifests variously. 47.67% of the cases is misdiagnosed at first visit. With the history and physical findings, PF is helpful in both determining the allergen（s） and guiding the management of MD.