皮肤癣菌和白念珠菌抗原在慢性荨麻疹患者中的致敏性及交叉反应研究

Study on dermatophyte and Candida albicans allergens in the sensitization and cross-reaction in patients with chronic urticaria

目的:制备红色毛癣菌、须癣毛癣菌、絮状表皮癣菌、白念珠菌抗原,并检测其在慢性荨麻疹、甲真菌病患者及正常受试者中的致敏性,从而评价皮肤癣菌感染在慢性荨麻疹中的病因学作用,并观察4种真菌抗原之间是否存在交叉反应。方法:174例慢性荨麻疹、甲真菌病患者和健康受试者,分为4组:①试验组:慢性荨麻疹并发甲真菌病患者(n=53);②对照组1:甲真菌病无变态反应性疾病患者(n=45);③对照组2:慢性荨麻疹无真菌感染患者(n=42);④对照组3:健康受试者(n=34)。所有受试者均进行4种真菌抗原点刺试验,试验组及对照组1进行真菌培养确定菌种。结果:试验组红色毛癣菌、絮状表皮癣菌、须发癣菌抗原点刺阳性率明显高于对照组1、2、3(P<0.05),对照组1高于对照组2和3(P均<0.05),差异有统计学意义,对照组2与对照组3比较(P>0.05),差异无统计学意义。4组白念珠菌抗原阳性率比较,差异无统计学意义(P>0.05)。试验组须癣毛癣菌、红色毛癣菌、絮状表皮癣菌抗原阳性率比较差异无统计学意义(P>0.05),3种皮肤癣菌抗原与白念株菌抗原之间比较,差异有统计学意义(P<0.05)。结论:皮肤癣菌感染是皮肤癣菌抗原阳性的重要决定因素,在部分慢性荨麻疹并发甲真菌病患者的病因中起重要作用,须癣毛癣菌、红色毛癣菌、絮状表皮癣菌抗原之间有明显的交叉反应,与白念珠菌抗原无交叉反应。

Objective： To prepare the extracts of Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton flocco- sum and Candida albicans, detect the sensitization of these four fungal extracts in the patients with chronic urticaria and ony- chomycosis, evaluate the dermatophyte infection in the etiologic role of chronic urticaria, and observe whether there is cross-re- action among these four fungal extracts. Methods： One hundred and seventy-four patients and healthy subjects participated in this study, with an average age of 35.7_＋13.5 years. They were divided into the following four groups： 1） study group： patients with chronic urticaria and onychomycosis （n = 53）; 2） control group 1： patients with onychomycosis without allergic diseases （n = 45）; 3） control group 2： patients with chronic urticaria without fungal infections （n = 42）; 4） control group 3： healthy subjects （n = 34）. All participants were performed skin prick tests with the four fungal extracts. The study group and control group 1 were also subjected to microscopic evaluation and fungal culture for fungal infection. Results： The positive rates of skin prick tests （SPTs） to Trichophyton rubrum, Epidermophyton floccosum, Trichophyton mentagrophytes extracts of the study group were signif- icantly higher than those in the control group 1, 2, 3 （P〈 0.05）; the control group 1 significantly higher than those in the con- trol group 2 and 3 （P〈 0.05）. There is no significant difference between group 2 and group 3. The SPTs positive rates to Can- dida albicans extract were of no significant difference among the four groups （P〉0.05）. In the study group, SPTs positive rates to Trichophyton rubrum, Epidermophyton floccosum, Trichophyton mentagrophytes extracts were of no significant difference （P 〉 0.05）, but the positive rates of three dermatophyte extracts were all higher than that of Candida albicans extracts （P 〈 0.05）. Conclusions： According to the above data, dermatophyte infection seems to be an important determinant in hypersensitivity to Trichophyton, it also plays an important etiologic role in the patients with chronic urticaria combined with onychomycosis. There are obvious cross-reactions among Trichophyton mentagrophytes, Trichophyton rubrum, Epidermophyton floccosum, but no cross-reaction between these three dermatophytes and Candida albicans extracts.