寻常性痤疮皮损患者感染病原菌特征、炎症因子和免疫水平及相关因素分析

The characteristics of pathogens,inflammatory factors,levels of immune function,and related risk factors in patients with acne vulgaris

目的探讨发生皮损的寻常性痤疮患者感染病原菌特征、炎症因子和免疫水平,以及影响病情严重程度的相关因素。方法选择2019年10月-2020年8月本院收治的寻常性痤疮患者281例,参照痤疮综合分级系统分为轻度组(1~18分,52例)、中度组(19~30分,103例)、重度组(31~38分,74例)和超重度组(>39分,52例)。采集患者皮损处标本,厌氧罐法进行病原菌的培养及鉴定;采集患者静脉血,ELISA法检测血清炎症因子水平,采用流式细胞仪检测T细胞亚群水平;收集患者临床资料,通过单因素和多因素Logistic回归分析确定寻常性痤疮严重程度影响因素。结果281例寻常性痤疮患者的皮损标本分离出216株厌氧菌,以痤疮丙酸杆菌(71.31%)、表皮葡萄球菌(18.53%)、颗粒丙酸杆菌(4.63%)和贪婪丙酸杆菌(1.85%)为主。4组患者间血清降钙素原、高敏C反应蛋白、白细胞介素-12、肿瘤坏死因子-(水平,以及CD3^(+)、CD4^(+)和CD8^(+)百分率差异均有统计学意义(均P<0.05)。其中超重度组降钙素原、高敏C反应蛋白、白细胞介素-12、肿瘤坏死因子-(水平和CD8^(+)百分率均显著高于其他三组(均P<0.05),CD3^(+)、CD4^(+)百分率显著低于其他三组(均P<0.05);重度组血清降钙素原、高敏C反应蛋白、白细胞介素-12、肿瘤坏死因子-(水平和CD8^(+)百分率显著高于中度组和轻度组(均P<0.05),CD3^(+)、CD4^(+)百分率显著低于中度组和轻度组(均P<0.05);中度组血清降钙素原、高敏C反应蛋白、白细胞介素-12、肿瘤坏死因子-(水平和CD8^(+)百分率显著高于对照组(均P<0.05),CD3^(+)、CD4^(+)百分率显著低于对照组(均P<0.05)。经单因素分析,寻常性痤疮病情严重程度与性别、初发年龄、每日洗脸次数、每日睡眠时间、皮肤类型、便秘、家族遗传史及季节等存在一定关系(均P<0.05);多因素Logistic回归分析显示,男性(OR=2.190,95%CI:2.179~3.319)、初发年龄(≤15岁)(OR=2.246,95%CI:1.169~4.313)、喜食咸味(OR=1.655,95%CI:1.143~2.398)和油性皮肤(OR=1.835,95%CI:1.502~2.241)等均是寻常性痤疮严重程度的独立影响因素(均P<0.05)。结论寻常性痤疮皮损处感染病原菌以痤疮丙酸杆菌、表皮葡萄球菌和颗粒丙酸杆菌等厌氧菌为主,炎症因子和免疫功能与寻常性痤疮病情严重程度相关,且性别、初发年龄、饮食习惯和皮肤类型等是病情严重程度的独立影响因素,可为寻常性痤疮的防治提供参考依据。

Objective To explore the characteristics of pathogens, inflammatory factors, levels of immune function, and related risk factors in patients with acne vulgaris. Methods Subjects were 281 patients with acne vulgaris seen at this Hospital from October 2019 to August 2020. In accordance with a comprehensive acne grading system, patients were divided into those with mild acne(a score of 1-18 points, n=52), those with moderate acne(a score of 19-30 points, n=103), those with severe acne(a score of 31-38 points, n=74), and those with extremely severe acne(a score >39 points, n=52). Specimens were collected from the patient’s skin lesions, and an anaerobic tank was used to culture and identify pathogens. The patient’s venous blood was collected, and the serum levels of inflammatory factors were determined using ELISA. Flow cytometry was used to detect levels of T cell subpopulations. Clinical data on patients were collected, and factors affecting the severity of acne vulgaris were determined through univariate and multivariate logistic regression analysis. Results Two hundred and sixteen strains of anaerobic bacteria were isolated from 282 patients with acne vulgaris. Those bacteria were mainly Propionibacterium acnes(71.31%), Staphylococcus epidermidis(18.53%), P. granulosum(4.63%), and P. avidum(1.85%). There were significant differences in serum levels of procalcitonin, high sensitivity C-reactive protein, and interleukin-12, and tumor necrosis factor-, and the percentage of CD3^(+), CD4^(+), and CD8^(+) cells among the four groups(P<0.05). The levels of procalcitonin, high-sensitivity C-reactive protein, interleukin-12, and tumor necrosis factor-and the percentage of CD8^(+) cells in patients with extremely severe acne were significantly higher than those in the other three groups(P<0.05 for all), and the percentage of CD3^(+) and CD4^(+) cells was significantly lower than that in the other three groups(P<0.05 for all). The levels of procalcitonin, high-sensitivity C-reactive protein, interleukin-12, and tumor necrosis factor-and the percentage of CD8^(+) cells in patients with severe acne were significantly higher than those in patients with moderate or mild acne(P<0.05 for all), and the percentage of CD3^(+) and CD4^(+) cells was significantly lower than that in patients with moderate or mild acne(P<0.05 for both). The levels of procalcitonin, high-sensitivity C-reactive protein, interleukin-12, and tumor necrosis factor-and the percentage of CD8^(+) cells in patients with moderate acne were significantly higher than those in the control group(P<0.05 for all), and the percentage of CD3^(+) and CD4^(+) cells was significantly lower than that in the control group(P<0.05 for all). Univariate analysis indicated that the severity of acne vulgaris was correlated with sex, age at onset, the number of times one washed one’s face daily, hours of sleep per day, skin type, constipation, family genetic history, and the season(P<0.05). Logistic multivariate analysis indicated that being male(OR=2.190, 95% CI:2.179-3.319), age at onset(≤the age of 15)(OR=2.246, 95% CI: 1.169-4.313), a preference for salty foods(OR=1.655, 95% CI: 1.143-2.398), and oily skin(OR=1.835, 95% CI: 1.502-2.241) were independent risk factors for the severity of acne vulgaris(P<0.05). Conclusion The infectious pathogens found in the skin lesions of acne vulgaris are mainly anaerobic bacteria such as P. acnes, S. epidermidis, and P. granulosum. Inflammatory factors and immune function are related to the severity of acne vulgaris. Sex, age at onset, eating habits, and skin type are independent factors affecting the severity of the disease. These findings may provide a basis for the prevention and treatment of acne vulgaris.