慢性光化性皮炎患者最小红斑量和T细胞亚群检测及临床疗效观察

Minimal Erythema Dose,T Cell Subset Level and Clinical Efficacy in Patients with Chronic Actinic Dermatitis

目的观察慢性光化性皮炎(chronic actinic dermatitis,CAD)患者最小红斑量(minimal erythema dose,MED)、硫嘌呤甲基转移酶(thiopurine methyltransferase,TPMT)基因型检测、外周血中T细胞亚群水平变化及临床疗效。方法采用日光模拟器对228例CAD患者和220例健康成年志愿者进行MED测定。采用流式细胞术和ABC-ELISA双抗体夹心法检测其外周血T淋巴细胞亚群、白介素12(IL-12)、γ-干扰素(IFN-γ)和外周血凋亡蛋白s Fas、s Fas L水平。CAD患者根据治疗方案分为硫唑嘌呤组(试验1组)和硫酸羟氯喹组(试验2组),试验1组治疗前予PCR技术进行TPMT基因型检测,治疗结束后将两组患者临床疗效进行比较。结果 CAD患者的长波紫外线最小红斑量(UVA-MED)、中波紫外线最小红斑量(UVB-MED)均低于正常对照组,试验组患者CD3+CD4+、CD3+CD4+/CD3+CD8+均显著低于正常对照组,CD3+CD8+显著高于正常对照组;试验组患者血清IFN-γ、IL-12、s Fas和s Fasl水平显著高于对照组,试验1组有效率(83.78%)显著高于试验2组有效率(64.04%),以上差异均有统计学意义(P均<0.05)。结论紫外线中的UVA和UVB在CAD发病中起重要作用。CAD患者存在不同程度免疫功能紊乱,T淋巴细胞参与其迟发型超敏反应,IFN-γ、IL-12、外周细胞凋亡蛋白在CAD发病中也起着重要作用。临床上治疗CAD时可以选择硫唑嘌呤或硫酸羟氯喹,但前者临床疗效优于后者。治疗前进行TPMT基因型检测可以指导临床药物的选择。

Objective To assess the minimal erythema dose（MED）,thiopurinemethy- ltranferase genotyping（TPMT）,changes in peripheral blood T cell subset level and clinical efficacy in patients with chronic actinic dermatitis（CAD）.Methods The MED of 228 patients with CAD and 220 healthy volunteers were measured using SUV1000 ultraviolet simulator. The flow cytometry and ABC-ELISA double antibody sandwich method were used to detect the peripheral blood T cell subset,IFN-γ,L-12, sFas and sFasL levels in the two groups. The patients were divided into two groups, i.e. azathioprin（treated group 1）and hydroxylchloroquine（treated group 2）.Polymerase chain reaction（PCR）was used to genotype the TPMT in the AZA group before treatment. The clinical efficacy were compared between the two groups.Results Both the UVA-MED and UVB-MED of the patients with CAD were significantly lower than that of normal controls（P〈0.05）.CD3＋CD4＋level and CD3＋CD4＋/CD3＋CD8＋ratios in CAD patients were significantly lower than those in the controls（P〈0.05）. In contrast, the CD3＋CD8＋ levels were significantly higher in CAD patients than that in the controls（P〈 0.05）.The serum levels of IFN-γ,IL-12,sFas and sFasL were also significantly higher in CAD patients than those in the controls（P〈0.05）. The effective rates in treated group 1 were higher than that in treated group 2（83.78%vs.64.04%,P〈0.05）. The effective rates in treated group 1 were higher than that in treated group 2（83.78%vs.64.04%,;0.05）.Conclusion Ultraviolet A and ultraviolet B radiation play an important role in the pathogenesis of CAD.CAD patients display some extent of immune dysfunction.T lymphocytes participate in the delayed type hyper sensitivity.IFN-γ,IL-12 and apoptotic proteins of peripheral cells play certain role in the pathogenesis of CAD. Both AZA and Hydroxychloroquine are effective for CAD, but the former exhibits superior efficacy. TPMT genotyping can help decide which drug to be used.