三氯乙烯药疹样皮炎患者补体3水平降低与肝功能损害关系分析

Analysis on relationship between content reduction of complement 3 and live impairment in patients with occupational medicamentosa-like dermatitis induced by trichloroethylene

目的探讨职业性三氯乙烯药疹样皮炎(OMDT)患者发病初期补体3(C3)水平降低与肝功能损害关系。方法收集182例确诊为OMDT的患者补体、肝功能和尿中三氯乙酸(TCA)等检查结果,根据发病初期C3水平分为C3降低组和C3正常组,根据发病初期前2次检查的间隔时间分为间隔1、2、3、4 d组和间隔≥5 d组。以发病初期丙氨酸氨基转移酶(ALT)和总胆红素(TBIL)水平判断肝功能损害及其程度。采用秩和检验和多因素非条件Logistic回归分析方法进行分析。结果 182例OMDT患者发病初期C3水平低于恢复期[0.86(0.76,1.04)vs 0.95(0.84,1.05)g/L,P<0.01]。发病初期C3降低组ALT和TBIL水平均高于C3正常组[628.0(155.3,1 009.5)vs282.5(113.0,738.8)U/L,75.2(16.3,204.2)vs 19.3(12.1,67.4)μmol/L,P<0.01]。发病初期重度肝功能损害患者C3水平分别低于肝功能损害轻微和轻度的患者[0.80(0.61,0.91)vs 0.91(0.81,1.08)g/L,0.80(0.61,0.91)vs 0.91(0.76,1.10)g/L,P<0.01]。发病初期5个时间间隔组2次C3水平分别比较,差异均无统计学意义(P>0.05);5个时间间隔组第2次ALT水平均低于第1次(P<0.05);TBIL水平除间隔1 d组外,其余4个时间间隔组第2次均低于第1次(P<0.05)。采用Logistic回归分析控制性别、年龄、TCE接触时间、尿中TCA水平和OMDT临床类型等混杂因素后,发病初期OMDT患者肝功能损害程度与C3水平降低有关(P<0.01)。结论 OMDT患者发病初期出现C3水平降低。肝功能损害程度越严重者C3水平越低,C3水平降低是肝功能损害导致C3合成不足引起的。

Objective To explore the relationship between the content reduction of complement 3 and live impairment in acute stage in patients with occupational medicamentosa-like dermatitis induced by trichloroethylene （OMDT）. Methods A retrospective analysis was conducted in 182 patients with OMDT. The patients＇ complement indicators, liver function en-zymes and urine trichloroacetic acid （TCA） were observed, and they were described with median （the twenty-fifth percen-tile, the seventy-fifth percentile）. According to the indicator in acute stage, patients were divided into C3 decline group and C3 normal group based on the C3 levels, and they were divided into interval day 1, 2, 3,4 and ≥day 5 groups based on the first 2 times test after the onset of the disease. Liver function damage and its extent （ slight-, mild-, moderate- and se- vere-degree） were determined by alanine amino transaminase （ALT） and total bilirubin （TBIL） level in acute stage. Rank-sum test and multivariate Logistic regression were used for analysis. Results The level of C3 on the acute stage was decreased significantly in comparison to those in the healing stage [ 0. 86 （ 0. 76,1.04 ） vs 0. 95 （ 0. 84,1.05 ） g/L, P 〈 0. 01 ]. The levels of ALT and TBIL in C3 decline group increased significantly in comparison to those in C3 normal group in acute stage [ 628. 0 （155.3,1 009.5） vs 282.5 （113.0,738.8） U/L, 75.2（16.3,204.2） vs 19.3 （12. 1,67.4） μmol/L, P 〈0. 01 ]. The C3 level of severe liver function damage patients in acute stage was decreased significantly in comparison to those of the patients slight and mild liver function damage respectively[0. 80（0. 61,0. 91 ） vs O. 91 （0. 81, 1.08 ） g/L, 0. 80 （0. 61,0. 91 ） vs 0. 91 （0. 76,1.10） g/L, P 〈 0. 01 ]. In acute stage, C3 level among the five time inter-val groups showed no statistical significant difference （ P 〉 0. 05 ） , and the second time ALT level was decreased signifi-cantly than those of the first time among the five time interval groups （ P 〈 0. 05 ）. In addition to the interval day 1 group, the second time TBIL level was decreased significantly than those of the first time among the rest 4 time interval groups （ P 〈 0. 05）. After adjustment by gender, age, trichloroethylene exposure time, TCA level and OMDT clinical phenotype, the Logistic analysis showed that increased liver function damage was associated with the reduction of C3 level （ P 〈 0.01 ）. Conclusion The liver impairment is most likely involved in the reduction of C3 in acute stage in patients with OMDT. The patients with more severity liver function damage were particularly prone to C3 levels decline.