慢性光化性皮炎患者24例外周血淋巴细胞亚群及临床分析

Peripheral Blood Lymphocyte Subsets and Clinical Analysis of 24 Cases of Chronic Actinic Dermatitis Patients

目的分析慢性光化性皮炎(CAD)患者外周血淋巴细胞亚群的变化,探讨CAD的临床特点及诊疗方法。方法回顾性分析24例CAD患者的临床资料,根据患者既往系统用药史分为单独抗组胺药(n=7)、联合羟氯喹(n=2)、联合糖皮质激素(n=5)、联合羟氯喹及糖皮质激素治疗组(n=8)。应用流式细胞仪检测其外周血T淋巴细胞、B淋巴细胞和自然杀伤细胞(NK)所占百分比及T细胞的绝对计数。结果 24例患者外周血中CD3+CD4+/CD3+CD8+比值增高,其中单独抗组胺药治疗组及联合糖皮质激素治疗组中的差异有统计学意义;既往系统使用糖皮质激素治疗的CAD患者中各T淋巴细胞绝对计数低于对照组,而未使用糖皮质激素者数值无显著差异。CAD患者平均发病年龄66.2岁,中老年男性占95.8%。无明显诱发因素,日晒可诱发或加重皮损。皮损分布主要在暴露部位,急性发作期以外用糖皮质激素软膏,内服抗组胺药、羟氯喹为主,必要时加用系统性使用糖皮质激素及免疫抑制剂。结论患者CD4+/CD8+比值增高,T淋巴细胞表达失衡,免疫系统紊乱;CAD的发生与日光照射密切相关,避光是治疗的关键,外用和内服药物对治疗有效。

Objective To analyze the peripheral lymphocyte subsets of patients with chronic actinic dermatitis （CAD） , investigate their clinical characteristics and treatment methods. Methods The clinical data of 24 cases with CAD were analyzed retrospectively. According to previous history of medication, patients were divided into antihistamine alone therapy group （ n = 7 ）, combined treatment with hydroxychloroquine （ n = 2）, combined treatment with glucocorticoids （ n = 5 ） and combined treatment with hydroxychloroquine and glucocorticoids （ n = 8）, respectively. Flow cytometry was used to detect the percentage of T lymphocytes, B lymphocytes and natural killer （NK） cells and the absolute counts of T lymphocytes in peripheral blood of the patients. Results Compared with the health group, the ratio of CD3^＋ CIM^＋/CD3^＋ CD8^＋ was increased in CAD group, only the differences between antihistamine alone therapy and combined treatment with glucocorticoids showed significance. Besides, the counts of T lymphocytes in CAD patients treated with systemic glucocorti- colds were lower than that in the control group, while there was no significant difference in patients who did not receive glucocorticoids. The average age of onset was 66. 2 years. Of the 24 patients, the middle and old aged male accounted for 95.8%. No precipitating factor was found in this study while all patients exhibited a light exacerbating history. Lesions were distributed primarily on the exposed skin. In the acute attack, topi- cal corticosteroid, oral antihistamines or hydroxylchloroquine could control the condition, even adding oral corticosteroid and immunosuppressive agents if necessary. Conclusion The ratio of CD4^＋/CD8^＋ was in- creased in CAD group, suggested that the lymphocyte subpopulation values observed in CAD patients wererelated to immunological unbalance. In clinical, CAD is closely related to sunlight, and sun-protect is the key to treatment. Both topical and oral treatments are effective.