慢性荨麻疹患者血浆TNF—α水平的变化及其临床意义

Plasma tumor necrosis factor-α concentration in patients with chronic urticaria and its clinical significance

目的观察慢性荨麻疹患者血浆TNF—α水平的变化，分析其与疾病严重程度和预后的相关性，探讨相关机制及临床意义。方法选取慢性荨麻疹患者66例（治疗组）和健康体检者20例（对照组），治疗前采血后以ELISA法检测比较两组对象的TNF-α水平，并根据临床评价进行分型，比较各型患者的TNF—α水平。治疗组患者给予口服咪唑斯丁片10mg，1次／d，连续服用28d；比较各级疗效患者的TNF—α水平，进行慢性荨麻疹治疗有效预测因素的分析。结果慢性荨麻疹患者血浆TNF—α水平显著高于对照组（P〈0.01），并与临床评价总积分明显正相关（P〈0.05）。治疗组中轻、中、重型患者血浆TNF-α水平两两比较，差异均有统计学意义（均P〈0.05）。治疗后痊愈28例，显效20例，好转18例，有效率为72.7％；痊愈、显效及好转患者治疗前血浆TNF—α水平两两比较，差异均有统计学意义（均P〈0.05）。多因素分析显示，血浆TNF—α水平是慢性荨麻疹治疗有效的预测因素；ROC曲线辨别了血浆TNF—α浓度的曲线下面积和判定界值（〈28.8ng／L），其对预测慢性荨麻疹治疗有效具有较高的灵敏度（69.4％）和特异度（67.3％）．结论TNF—α可能参与了慢性荨麻疹的病理生理过程，其水平可以反映病情严重程度及转归，可用于疾病的疗效评价。

Objective TO investigate plasma tumor necrosis factor- α （TNF- α ） level in patients with chronic urticaria and its clinical significance. Methods Sixty six patients with chronic urticaria and 20 healthy controls were enrolled in this study. Patients were graded into mild, moderate and severe groups according to symptom score, Plasma TNF-α levels were measured by ELISA measured. Patients with urticaria received oral medication of 10 mg mizolastine per day for 28 d. Results Plasma TNF-α levels of patients with chronic urticaria were significantly higher than those of healthy controls （P〈0.01）, and were positively correlated with their symptom score （P〈0.05）. The intergroup differences in plasma TNF- α level were significant among mild, moderate and severe group （P〈0.05）. After treatment complete remission was obtained in 28 cases, remission in 20, partial remission in 18 with a remission rate of 72.7% （48/66）. The intergroup differences in plasma TNF- α level were significant among complete remission, remission and partial remission groups （P〈0.05）. A forward stepwise logistic regression selected plasma TNF-α level as an independent predictor for a good outcome. A receiver operating characteristic （ROC） curve identified area under curve and cutoff level of plasma TNF- α（〈28.8 ng/L） that predicted a good outcome of patients with the high sensitivity （69.4%） and specificity values （67.3%）. Conclusion Plasma TNF-α may be involved in pathogenesis of chronic urticaria. Plasma TNF- α levels may reflect the disease severity and can be used for therapeutic evaluation and disease prognosis.