应用斑贴试验检测过敏原在皮炎和湿疹诊断中的临床价值分析

Clinical value of patch test in diagnosis of dermatitis and eczema

目的探讨氯化钴等20种过敏原在皮炎、湿疹发生发展中的作用及其检测对临床诊疗的应用价值。方法选取2016年至2020年来广州市皮肤病防治所就诊且临床诊疗资料基本齐备的248例皮炎、湿疹患者作为分析对象,其中皮炎患者144例(男17例、女127例),年龄4~75岁;湿疹患者95例(男27例、女68例),年龄2~78岁。对其氯化钴、疏基化合物、咪唑烷基脲、对苯二胺、N-环已基硫酞内酯、夸特15等20种过敏原斑贴试验的72 h观察结果进行回顾性分析研究。统计学方法采用χ^(2)检验。结果在皮炎、湿疹患者中,硫酸镍、氯化钴、芳香混合物Ⅰ3种过敏原阳性率均居前3位,其阳性率分别为29.17%(42/144)、19.44%(28/144)、9.72%(14/144)和21.05%(20/95)、16.84%(16/95)、11.58(11/95)。在皮炎患者中,男女比例为1.00:7.47,过敏原阳性检出率分别为47.06%(8/17)、66.93%(85/127);少年、青年、中年、老年比例为1.00:23.00:3.80:1.00,其过敏原阳性检出率分别为20.00%(1/5)、66.09%(76/115)、57.89%(11/19)、100%(5/5),各年龄组间差异有统计学意义(χ^(2)=9.02,P<0.05);1种、2种与3种及以上过敏原阳性患者百分率为29.17%(42/144)、19.44%(28/144)、15.97%(23/144),三者间差异有统计学意义(χ^(2)=7.98,P<0.05)。在湿疹患者中,男女比例为1.00:2.52,过敏原阳性检出率分别为51.85%(14/27)、64.71%(44/68);少年、青年、中年、老年比例为1.00:14.25:5.75:2.75,其过敏原阳性检出率分别为25.00%(1/4)、63.16%(36/57)、52.17%(12/23)、81.82%(9/11);1种、2种与3种及以上过敏原阳性患者百分率分别为36.84%(35/95)、8.42%(8/95)、15.79%(15/95),三者间差异有统计学意义(χ^(2)=25.50,P<0.05)。结论硫酸镍、氯化钴、芳香混合物Ⅰ3种过敏原为皮炎、湿疹的高发诱因,然而对于所有过敏原而言,性别、年龄、不同数量的过敏原阳性检出率之间则存在不同差异性的特点,因此,应用斑贴试验检测过敏原有助于皮炎和湿疹的诊断与鉴别诊断。

Objective To investigate the role of 20 allergens(cobalt chloride,etc.)in the disease process of dermatitis and eczema,and to evaluate the value of testing these allergens in the diagnosis and treatment.Methods A total of 248 patients with dermatitis or eczema who were treated in Guangzhou Institute of Dermatology from 2016 to 2020 and had basically complete clinical diagnosis and treatment data were selected as the analysis objects.Among them,there were 144 patients with dermatitis,including 17 males and 127 females who were 4-75 years old,and 95 patients with eczema,including 27 males and 68 females who were 2-78 years old.The 72 h observation results of 20 kinds of allergen patch tests,such as cobalt chloride,hydrophobic compounds,imidazolyl urea,p-phenylenediamine,N-cyclohexyl thiophthalide lactone,and Quartet 15,were retrospectively analyzed.χ^(2)test was applied.Results The allergen positive rates of nickel sulfate,cobalt chloride,and aromatic mixture I were the top three,and were 29.17%(42/144),19.44%(28/144),and 9.72%(14/144)in the 144 patients with dermatitis and were 21.05%(20/95),16.84%(16/95),and 11.58%(11/95)in the 95 patients with eczema,respectively.In the patients with dermatitis,the ratio of male to female was 1.00∶7.47,and the positive rates of all allergens were 47.06%(8/17)and 66.93%(85/127),respectively;the ratio of adolescents to young adults to middle-aged adults to the elderly was 1.00∶23.00∶3.80∶1.00,and the positive rates of all allergens were 20.00%(1/5),66.09%(76/115),57.89%(11/19),and 100.00%(5/5),respectively,with a statistical difference(χ^(2)=9.02,P<0.05);the positive rates of one,two,and three or more kinds of allergens were 29.17%(42/144),19.44%(28/144),and 15.97%(23/144),respectively,with a statistical difference(χ^(2)=7.98,P<0.05).In the patients with eczema,the ratio of male to female was 1.00:2.52,and the positive rates of all allergens were 51.85%(14/27)and 64.71%(44/68)respectively;the ratio of adolescents to young adults to middle-aged adults to the elderly was 1.00:14.25:5.75:2.75,and the positive rates of all allergens were 25.00%(1/4),63.16%(36/57),52.17%(12/23),and 81.82%(9/11),respectively;the positive rates of one,two,and three or more kinds of allergens were 36.84%(35/95),8.42%(8/95),and 15.79%(15/95),respectively,with a statistical difference(χ^(2)=25.50,P<0.05).Conclusions Nickel sulfate,cobalt chloride,and aromatic mixture I are the high-risk causes of dermatitis and eczema.However,for all allergens,there are different characteristics of variability between allergen positive detection rates in different gender,age,and quantities,so the application of patch test for allergens is helpful for diagnosis and differential diagnosis.