慢性荨麻疹的真菌病因及治疗

Role of fungi in pathogenesis and antifungal treatment in chronic urticaria

目的：探索慢性荨麻疹中的真菌病因及治疗对策。方法：应用混合真菌（点青霉、蜡叶支孢霉、烟曲霉、白色念珠菌、细链格胞）抗原测定了１２８例慢性荨麻疹病人血清中的特异性ＩｇＥ抗体［Ｓ＿ＩｇＥ（ＭＰ１）］，其中５０例阳性随机平分２组，Ａ组以常规抗组胺药物治疗，Ｂ组加用氟康唑１５０ｍｇ／ｗｋ，ｐｏ，×８ｗｋ，治疗停止及停止后６～８ｗｋ评定疗效。结果：疗程结束时差异不显著，疗程结束后６～８ｗｋＡ组的治愈率、显效率及积分下降率分别为４％，２０％及３３％；Ｂ组分别为４０％，３２％及６５％，（Ｐ＜０．０１）；复查Ｓ＿ＩｇＥ（ＭＰ１），Ａ组复查１３例无一例阴转，Ｂ组复查１９例中１７例阴转（８９％）。结论：Ｓ＿ＩｇＥ（ＭＰ１）阳性的荨麻疹病人中体内真菌致敏可能为其重要的病因，应用抗真菌药物治疗具有临床实际意义。

AIM: To investigate the role of the fungi in the pathogenesis and antifungal treatment in chronic urticaria. METHODS: One hundred and twenty-eight patients with chronic urticaria were tested for the serum specific IgE antibody (S-IgE) to a mixed fungal antigen (MP1: Penicillum notatum, Cladosporium herbarium, Spergillus fumigatus, Candida albicans, Alternaria tenuis), and 50 patients (39%) were positive. These patients were treated with antihistaminics and equally divided into 2 group, group A and group B. Group B was added with fluconazole 150 mg po once 1 wk ×8 wk. RESULTS: Cure and markedly improved rates were not significantly different between the 2 groups by the end of the course, but the cure rates (4% vs 40%), total markedly improved rates (20% vs 32%) and the decreases of scores (33% vs 65%) were different (P<0.01) between the 2 groups by 6_8 wk after stopping the treatment. 13 patients in group A and 19 in group B were retested for the S_IgE(MP1) after the treatment. Group A showed all positive while Group B showed negative in 17 patients (89%). CONCLUSION: The sensitization by the fungi plays an important role in the pathogenesis of patients of chronic urticaria with positive S_IgE(MP1), and antifungal treatment is needed.