IFN-γ、IL-2检测对药疹诊断价值的探讨

Etiology Diagnostic value of IFN-γ,IL-2 Detection for Drug Eruption

目的探讨IFN-γ,IL-2检测对药疹的病因学诊断价值。方法发疹型药疹及固定型药疹病例进行药物斑贴试验,从中筛选药物斑贴试验阳性患者纳入试验组;既往病史中有明确相同药物所致药疹史者纳入试验组;重症药疹病例选择ALDEN评分≥6分者纳入试验组;同时选择健康人进行药物斑贴试验,从中筛选药物斑贴试验阴性者纳入正常对照组,共30人参与体外试验。所有受试者各采血15 mL,提取外周血单个核细胞(PBMC),加入相应药物刺激,在体外共培养48 h后,用ELISpot(Enzyme-linked immenospot)检测细胞因子IFN-γ和IL-2释放水平。ELISpot检测设立阴性对照及阳性对照。应用受试者特征工作曲线(ROC)来评价ELISpot细胞因子释放试验检测IFN-γ和IL-2在药疹中的诊断价值。结果 ELISpot检测显示,经致敏药物刺激后,试验组PBMC的IFN-γ、IL-2的释放量明显高于正常人组,差异有统计学意义(P<0.05)。试验组经致敏药物刺激后IFN-γ、IL-2的释放量与阴性对照比较也显著升高,差异有统计学意义(P<0.05),正常人组无类似反应。IFN-γROC曲线下面积、灵敏度、特异度分别为0.82,85.70%和81.30%;IL-2分别为0.86,68.80%和92.90%。结论 IFN-γ和IL-2检测对于药疹诊断以及明确药物致敏原,指导患者避免接触有相同或相似分子结构及功能基团的药物,从而避免药疹发生和恶化,预防药疹再次发作有重要意义。

Objective To evaluate the diagnostic values of IFN-γ,IL-2 detection drug eruption. MethodsThe patients of maculopapule eruption and fixed drug eruption received patch test,and then the positive patients were screened to include in the experimental group;the patients with a medical history of drug eruption caused by the same drugs were incorporated in the experimental group;severe drug eruption cases ALDEN score ≥6 were also included in the experimental group;meantime,healthy people with negative patch test were selected into the normal control. Thirty cases were participated in the vitro tests. 15mL blood samples were collected from all participants,outer peripheral mononuclear cells were extracted,adding the appropriate medication,cultured 48 hours in vitro. IFN-γ,IL-2 release levels were detected by ELISpot. Negative controls and positive controls were established. The receiver operating characteristic curve (ROC curve) was applicated to evaluate ELISpot cytokine release assay diagnostic values in drug eruption. ResultsFor the ELISpot test,after stimulated by sensitizing drugs,the IFN-γ,IL-2 release of PBMC in allergy group were significantly higher than the normal group (P<0.05). The release of IFN-γ,IL-2 in allergy group increased significantly compared to the negative control group (P<0.05),but the normal group had no similar reaction. Area under the ROC curve,sensitivity and specificity of IFN-γ were 0.82, 85.70%,81.30%,IL-2 were 0.86,68.80%,92.90%,respectively. ConclusionIFN-γ and IL-2 detection are important for diagnosis and determination of drug allergens,and to instruct patients to avoid contact with the same or similar molecular structure and functional groups of drugs,thus avoiding deterioration and preventing recurrence.