慢性光化性皮炎最小红斑量、光斑贴试验及有关机理研究

The role of minimal erythema dose and photopatch test in the pathogenesis of chronic actinic dermatitis

目的分析云南地区慢性光化性皮炎(chronic actinic dermatitis CAD)患者最小红斑量和光斑贴试验的情况,探讨IL-6、TNF-α与CAD发病的相关性。方法采用SUV 1000型日光模拟器对21例CAD患者和40例正常对照者进行最小红斑量的测定。采用SS-03AB型紫外线光疗仪和标准光斑贴试验试剂盒对21例CAD患者和21例正常对照者进行光斑贴试验(光源:UVA 5J/cm2)。采用酶联免疫吸附法检测CAD患者、正常对照者血清中IL-6、TNF-α的含量。结果 1 CAD患者的UVAMED、UVB-MED较正常人对照组明显降低(P<0.05)。且CAD患者的MED值与皮肤类型无关(P>0.05),正常对照组的MED值与皮肤类型、性别均无关(P>0.05);2 CAD患者、正常人中光斑贴试验阳性率分别为57.1%,47.6%。CAD患者最常见的光变应原依次为芳香混合物、D-松萝酸、木材合成物;正常人最常见的光变应原依次为芳香混合物、D-松萝酸、秘鲁香脂;3 IL-6在CAD患者组的含量低于正常人对照组(P<0.05)。TNF-α在两组中的差异无统计学意义(P>0.05)。结论最小红斑量的测定提示CAD的发病与UVA、UVB的照射有关,其中UVA更为敏感;CAD患者及正常人对照组都对多种(光)接触性变应原呈阳性反应;CAD的发病可能和IL-6的降低有一定的关系。

Objective To analyze the role of the minimal erythema dose and photopatch test in the pathogene- sis of chronic actinic dermatitis （CAD） and to investigate the expression of IL-6 and TNF-α in the patient with CAD. Methods The minimal erythema dose （MED） of 21 patients with CAD and 40 normal controls were measured by SUV 1000 type ultraviolet simulator. Photopatch test was performed on 21 patients with CAD and 21 normal con- trols by standard photopatch test kit, then they were irradiated by SS-03AB type ultraviolet phototherapy instrument. The ultraviolet A （5J/cm2） was used as the source of irradiation. The serum levels of IL-6 and TNF-α of patients with CAD and normal controls were tested by ELISA. Results The UVA-MED and UVB-MED of patients with CAD were signifieantly less than that of normal controls （P〈0.05）. The MED of patients with CAD between men and women were not significant differences, also in normal control （P〉0.05）. The photopatch test results have shown that the positive rates were 57.1% and 47.6% in the patients with CAD and the normal controls respectively. The most common photo allergens of patients with CAD were fragranee mixture, D-usnic acid and wood composites. The fra- grance mixture, D-usnic acid and balsam of Peru were the most common photo-allergens in the normal controls, The serum level of IL-6 in CAD group was significantly decreased than that of the control group（P〈0.05）. The level ofTNF-α were no significant differences between the patient and normal controls （P〉0.05）. Conclusion The ultravio- let A and ultraviolet B radiatiation may play an important role in the pathogenesis of CAD, which is more sensitive to UVA. The photopatch test results have shown that positive reactions iora variety of allergens in CAD patients and healthy controls. The lower level of IL-6 may play a role in the pathogenesis of CAD.