糖皮质激素联合丙种球蛋白对重症药疹患者TNF-α表达水平的影响

Study on Effect of Glucocorticoid and Gamma Globulin on TNF-α Expression in Patients with Severe Drug Eruption

目的:检测糖皮质激素和丙种球蛋白对重症药疹皮肤组织和血液中TNF-α表达水平的影响,探讨糖皮质激素和丙种球蛋白治疗重症药疹的作用机制。方法:收集临床正常人和重症药疹经糖皮质激素和丙种球蛋白治疗前、后的皮肤组织标本,采用免疫组化染色法(IHC)检测组织中TNF-α蛋白的表达,用酶联免疫吸附法(ELISA)检测血液TNF-α的含量。结果:与正常对照组相比,重症药疹患者皮损组织TNF-α蛋白表达阳性率升高,平均染色强度增强,二者差异具有统计学意义(P<0.01),且重症药疹组患者血液中TNF-α的含量较正常组高。经过糖皮质激素和丙种球蛋白治疗28d后,皮损组织和血液中TNF-α的表达水平降低,接近正常人水平,二者差异无统计学意义(P>0.05)。结论:TNF-α在重症药疹皮损中表达明显升高,与重症药疹引起的表皮坏死和细胞凋亡相关,糖皮质激素和丙种球蛋白治疗可以降低TNF-α的表达,可能是治疗重症药疹的作用机制之一。

Objective： To investigate the effect of glucocorticoid and gamma globulin on T NF-α expression and explore its mechanism of action in the treatment of Severe Drug Eruption Methods ： Collecting healthy people and the patients with severe drug eruption before and after treatment. T he expression of TNF -α proteinin the skin tissue was evaluated by Immunohistochemical staining method. T h e expression o f TNF -α in bloodwas evalu-ated by ELISA Results： Compared wi th normal control g ro u p , the positive rate of TNF -α increased （20. 00% and 69. 23% respectively） , th e average staining inte n s ity was signif icant ly increawith severe drug erupt ion , there were statistical significance （P〈0. 01）. Patients with severe drug er levels TNF-α in blood than normal group. Af te r 28 days after taking medicine, the expression of TNF -α was signiticantly decreased in skin tissue and b lo o d,and there was no statistical significance compared w i th the control group （P〉 0. 05）. Conclusion： TNF-α expression was sign if ica n t ly increased in the patients w i th severe drug e ru p t io n , which m ight contribute to epidermal necrosis and apoptosis. Glucocorticoid and gamma glo b u l in treatmentsion of TNF-α which may be one of mechanism in the treatment of Severe Drug Eruption .