哮喘患者穴位贴敷后不同程度急性接触性皮炎临床特点及胸腺基质淋巴细胞生成素表达差异性研究

Clinical Features of Varying Degrees of Acute Contact Dermatitis and Difference in the Expression of Thymic Stromal Lymphopoietin after Acupoint Application in Patients with Asthma

目的采用穴位贴敷治疗哮喘患者,观察其诱发的不同程度急性接触性皮炎临床特点及胸腺基质淋巴细胞生成素(thymic stromal lymphopoietin,TSLP)表达的差异性。方法收集110例哮喘缓解期患者,按贴敷后皮肤反应程度分为轻度组及中重度组,比较两组患者治疗前后喘息、哮鸣音、发作次数及临床疗效,观察两组肉眼下皮损表现、皮损病理学以及TSLP的表达。结果中重度组患者贴敷后喘息、哮鸣音、发作次数及临床疗效均优于轻度组(P<0.05)。轻度组患者只有少数感到贴敷处痛痒、红斑、小丘疹或簇状小水疱,中重度组贴敷处痛痒难忍、红斑、水疱程度重于前者。病理学示轻度组表现为血管周围少量单核细胞、淋巴细胞及嗜酸性粒细胞浸润,中重度组表现为真皮血管扩张、充血明显,其周围大量单核细胞、淋巴细胞浸润。光镜下TSLP在轻度组主要分布于表皮全层,中重度组大量分布于真皮层血管周围。TSLP表达量与穴位贴敷后急性接触性皮炎炎性程度呈正相关(r=0.908,P<0.05)。结论穴位贴敷诱发的急性接触性皮炎炎症程度与临床表现及TSLP表达呈正相关,可能与真皮血管关系密切。

Objective To investigate the clinical features of varying degrees of acute contact dermatitis and difference in the expression of thymic stromal lymphopoietin （TSLP） induced by acupoint application in patients with asthma.Methods A total of 110 patients with the remission stage of asthma were enrolled, and according to the degree of skin reaction after acupoint application, the patients were divided into mild group and moderate-to-severe group.The two groups were compared in terms of wheezing, wheeze, number of attacks, and clinical outcome, and macroscopic skin lesion, pathology of skin lesion, and expression of TSLP were observed in both groups.Results Compared with the mild group, the moderate-to-severe group had significantly reduced symptoms of wheezing and wheeze, a significantly lower number of attacks, and a significantly better clinical outcome after acupoint application （P〈0.05）.The patients in the mild group experienced pain and itching, erythema, papules, or clusters of small blisters at the site for acupoint application, and those in the moderate-to-severe group experienced unbearable pain and itching and more severe erythema and blisters.Pathological examination showed perivascular infiltration of monocytes, lymphocytes, and a small number of eosinophils in the mild group and dermal vasodilation, marked congestion, and infiltration of large numbers of monocytes and lymphocytes in the moderate-to-severe group.In the mild group, TSLP was mainly distributed in the epidermis, while in the moderate-to-severe group, it was mainly distributed in the perivascular area in the dermis.The expression of TSLP was positively correlated with the degree of acute contact dermatitis after acupoint application （r=0.908, P〈0.05）.Conclusion The degree of acute contact dermatitis induced by acupoint application is positively correlated with clinical manifestation and TSLP expression, which may be closely associated with dermal blood vessels.