慢性自发性荨麻疹患者自体血清皮肤试验的免疫学机制及与临床特征和预后的关系

Autologous serum skin test:immunological mechanisms and its associations with clinical features and prognosis of chronic spontaneous urticaria

自体血清皮肤试验(ASST)在临床上常用于筛查慢性自发性荨麻疹(CSU)的免疫亚型,但其免疫学机制、与CSU患者临床特征及预后的关系尚未明确。研究显示,ASST阳性与CSU患者免疫球蛋白G自身抗体升高、嗜酸性粒细胞和嗜碱性粒细胞计数减少、嗜碱性粒细胞CD63表达升高、循环炎症细胞因子水平变化相关,与患者年龄、病程以及个人或家族史无关,但可能是慢性荨麻疹病情严重程度的预测指标。ASST阳性患者可能对第二代H1抗组胺药反应不佳,对奥马珠单抗起效缓慢,但对环孢素和自体全血/血清注射治疗反应良好。该文综述ASST阳性患者的免疫学和临床特征,探讨ASST阳性对不同治疗方案疗效的预测作用。

Autologous serum skin test(ASST)is commonly used as a screening test to assess immune subtypes of chronic spontaneous urticaria(CSU)in clinical practice,but its immunological mechanisms and associations with clinical features and prognosis of CSU are not yet clear.Studies have shown that positive ASST is associated with increased immunoglobulin G autoantibodies,decreased eosinophil and basophil counts,increased CD63 expression on basophils,and changes in circulating inflammatory cytokine levels in CSU patients,but not associated with age,disease duration,and personal or family history of CSU patients,and may be a predictor of severity of chronic urticaria.ASST-positive patients may respond poorly to second-generation H1 antihistamines,slowly to omalizumab,but respond well to cyclosporine and autologous whole blood/serum injections.This review summarizes the immunological and clinical characteristics of ASST-positive patients,and discusses the predictive value of positive ASST for the efficacy of different treatment regimens.