颗粒溶素在不同类型药疹患者中的表达

Expression of granulysin in patients with different types of drug eruption

目的比较不同类型药疹患者血清学及细胞中颗粒溶素表达差异。方法酶联免疫吸附试验（ELISA）和流式细胞仪分别检测7例中毒性表皮坏死松解症、5例Stevens—Johnson综合征进展期患者、8例多形红斑药疹患者、8例发疹型药疹患者及11例健康人血清及外周血T细胞中颗粒溶素的表达水平。利用SPSSl7．0进行统计学分析，两组均数比较采用随机或配对t检验，3组间比较采用ANOVA分析。结果中毒性表皮坏死松解症和Stevens-Johnson综合征急性期患者血清颗粒溶素水平为（0．196±0，079）μg／L，明显高于发疹型药疹患者[（0．022±0．003）μg，L]和健康对照[（0．013±0．005）μg／L]，F=3．926，P〈0．05，但与多形红斑患者[（0．058±0，004）μg／L]相比差异无统计学意义。Stevens-Johnson综合征患者和中毒性表皮坏死松解症患者表达颗粒溶素的CD8＋T细胞比例为（3．400±0．754）％，多形红斑组为（0．600±0．250）％，发疹型药疹组和健康对照组分别为（0．342±0．251）％和（0．054±0．024）％，4组间差异有统计学意义，F=11．4，P〈0．01。结论颗粒溶素在中毒性表皮坏死松解症、Stevens—Johnson综合征患者中表达水平较高，可能对该病急性期的鉴别诊断及预后评价具有潜在的应用价值。

Objective To compare the cellular and serum expression levels of granulysin among patients with different types of drug eruption. Methods Blood samples were collected from 7 patients with toxic epidermal necrolysis （TEN）, 5 patients with acute Stevens-Johnson syndrome （SJS）, 8 patients with erythema multiforme, 8 patients with exanthematic drug eruption, and 11 healthy controls. Flow cytometry and enzyme-linked immunosorbent assay （ELISA） were performed to quantify the protein expression of granulysin in peripheral blood T cells and sera from these subjects, respectively. Data were processed by the SPSS17.0 software, and differences in these parameters were analyzed by one-way analysis of variance and independent or paired sample t-test. Results The serum level of granulysin in patients with TEN or acute SJS was significantly higher than that in those with exanthematic drug eruption and healthy controls （（0.196 ± 0.079） μg/L vs. （0.022 ± 0.003） μg/L and （0.013 ± 0.005 ） μg/L, F = 3.926, P 〈 0.05）, but similar to that in those with erythema multiforme （ （0.058 ± 0.004 ） μg/L, P 〉 0.05）. Significant differences were observed in the proportion of CD8＋ T ceils expressing granulysin in peripheral blood mononuclear cells （PBMCs） between patients with TEN or acute SJS, erythema muhiforme, exanthematic drug eruption, and healthy controls （（3.400 ± 0.754）% vs. （0.600 ± 0.250）% vs. （0.342 ± 0.251）% vs. （0.054 ± 0.024）%, F = 11.4, P 〈 0.01 ）. Conchtsions Granulysin is highly expressed in patients with TEN and SJS, which may have potential value for their differential diagnosis and prognosis evaluation at acute phase.