慢性荨麻疹患者血清IgE和IgE受体及其自身抗体的表达及意义

Expression and relevance of serum IgE,IgE receptors and autoantibodies in patients with chronic urticaria

目的:探讨慢性荨麻疹(CU)患者血清免疫球蛋白E(IgE)、可溶性IgE高亲和力受体α(sFcεRⅠα)、IgG型抗IgE、IgG型抗FcεRⅠ自身抗体的水平及意义。方法:收集2018年1至7月于上海市第一人民医院首诊的43例CU患者作为CU组,同时选择37例皮炎湿疹患者及51名健康体检者分别作为疾病对照(DC)组及健康对照(NC)组。采用免疫比浊法检测血清IgE,酶联免疫吸附试验(ELISA)检测抗IgE、抗FcεRⅠ和sFcεRⅠα。采用非参数检验分析各组指标水平的差异,Spearman相关分析评估各指标间的相关性及其与病情的关系,受试者工作特征曲线分析各指标诊断价值。结果:CU组血清IgE、抗IgE、抗FcεRⅠ水平显著高于NC组,中位数分别为65.70 IU/ml比17.10 IU/ml,χ^2=28.541,P=0.001;0.61比0.39,χ^2=27.408,P=0.001;0.64比0.51,χ^2=29.102,P<0.001。CU组抗FcεRⅠ水平显著低于DC组,0.64比0.83,χ^2=25.869,P=0.007。CU、DC、NC组血清sFcεRⅠα中位数分别为5.74、5.38和4.50 ng/ml,差异无统计学意义,χ^2=3.463,P=0.177。IgE与sFcεRⅠα、抗IgE与抗FcεRⅠ水平呈正相关(r=0.455,P<0.001;r=0.611,P<0.001)。四指标与病程、症状严重程度无明显相关关系,P>0.05。IgE、抗IgE、抗FcεRⅠ对CU的诊断效能(AUC均=0.72)优于sFcεRⅠα(AUC=0.61),四项联合检测可达最高诊断效能(AUC=0.83);抗FcεRI对CU与DC具鉴别诊断价值,AUC=0.70,P=0.002。结论:CU患者血清IgE、抗IgE及抗FcεRⅠ水平显著升高。肥大细胞活化相关分子具有成为CU诊断指标的潜能。

Objective To detect serum levels of immunoglobulin E(IgE),soluble version of the IgE-binding alpha-chain of Fcepsilon-RI(sFcεRIα),immunoglobulin G(IgG)anti-IgE,IgG anti-FcεRI in patients with chronic urticaria(CU),and to evaluate their relevance Methods Forty-three newly diagnosed patient with CU were enrolled.Thirty-seven patients with dermatitis or eczema and 51 healthy subjects were selected as the disease control(DC)and normal control(NC)group,respectively.Serum IgE was detected by immunoturbidimetry;serum anti-IgE,anti-FcεRⅠand sFcεRⅠαwere determined byenzyme-linked immunosorbent assay(ELISA)methods.Statistical analysis was carried out by non-parametric test for comparisons of the above variables between groups,and by Spearman correlation analysis for assessment of relationships between the variables as well as between the variables and disease severity,and by receiver operating characteristic curve to analyze the diagnostic value of the variables.Results Serum IgE,anti-IgE and anti-FcεRI in CU were significantly higher than that of NC.Their medians are 65.70 IU/ml vs 17.10 IU/ml,χ^2=28.541,P=0.001;0.61 vs 0.39,χ^2=27.408,P=0.001;0.64 vs 0.51,χ^2=29.102,P<0.001.Serumanti-FcεRI in CU was significantly lower than that in NC(0.64 vs 0.83,χ^2=25.869,P=0.007).The medians of serum sFcεRIαin CU,DC and NC groups were 5.74,5.38,4.50 ng/ml,respectively.The difference was not statistically significant,χ^2=3.463,P=0.177.There was a positive correlation between IgE and sFcεRⅠα,anti-IgE and anti-FcεRI(r=0.455,P<0.001;r=0.611,P<0.001).No significant correlation was showed between the four variables and the course of disease or the severity of symptoms,P>0.05.The diagnostic performances of IgE,anti-FcεRI for CU were similar(AUC=0.72),which were better than that of sFcεRIα(AUC=0.61).The highest diagnostic efficacy(AUC=0.83)can be achieved by four joint tests.Anti-FcεRI is of value in differential diagnosis of CU and DC,AUC=0.7,P=0.002.Conclusion The levels of serum IgE,anti-IgE,anti-FcεRI were significantly increased in CU patients,and these mast cell activation-related molecules have the potential to be diagnostic markers for CU.