自体全血注射对自身反应性慢性荨麻疹患者血浆IgG抗FcεRI自身抗体、总IgE水平和嗜碱性粒细胞FcεRIα表达的影响
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摘要
目的研究ASST阳性慢性自发性荨麻疹(CSU)患者接受自体全血注射(AWBI)治疗前后血浆IgG抗FcεRI、总IgE以及嗜碱性粒细胞FcεRIα表达的变化,探讨AWBI治疗机制。方法收集ASST阳性CSU患者80例,随机分成AWBI组和对照组各40例,AWBI组接受每周1次自体全血注射治疗,共12次,同时给予第2代抗组胺药治疗,对照组单纯使用第2代抗组胺药治疗。连续治疗12周,评估治疗前后2组荨麻疹活动程度评分(UAS)的差异。治疗前后用ELISA或流式细胞术检测AWBI组血浆IgG抗FcεRI、总IgE及嗜碱性粒细胞FcεRIα表达的变化。另外选取25例健康人作为体外试验的健康对照组。结果治疗后AWBI组显效率为60%(24/40),显著高于对照组显效率27.27%(9/40)(P<0.01)。AWBI组治疗后血浆IgG抗FcεRI质量浓度以及嗜碱性粒细胞FcεRIα表达显著下降(P均<0.05);总IgE水平无明显变化(P>0.05)。这3种免疫因子的基线值与UAS评分变化值均呈不同程度的正相关。结论自体全血注射治疗ASST阳性慢性荨麻疹能明显改善临床症状,其机制与下调血浆IgG抗FcεRI与嗜碱性粒细胞FcεRIα表达有关。
This study was desiged to analyze the clinical efficacy of autologous whole blood injection(AWBI)on plasma IgG anti-FcεRI, total IgE, basophil FcεRI receptor expression in ASST-positive chronic spontaneous urticaria(CSU). Total of 80 patients with ASST+CSU were recruited and randomly divided into AWBI group and control group, with 40 cases in each group. Second-generation H1-antihistamines were given to all the patients,while patients in AWBI group were also injected with autologous whole blood once a week for 12 times. Patients were evaluated by urticaria activity score(UAS) before and after treatment; the levels of plasma IgG-anti-FcεRI,total IgE and basophil FcεRIα expression were measured by ELISA or flow cytometry before and after treatment. In addition, healthy volunteers(n=25) were collected as healthy control group. Data showed that after treatment, the notable effective rate of AWBI group was 60%(24/40), which was markedly higher than that of the control group(27.27%, 9/40). Levels of plasma IgG anti-Fc εRI and basophils FcεRIα in ASST+patients after AWBI were significantly lower than that before AWBI, but no significant difference observed in total IgE. The baseline levels of IgG anti-FcεRI, total IgE and basophil FcεRIα were positively correlated with UAS variation in varying degrees. Results in this study demonstrate marked therapeutic effect of autologous whole blood injection in patients with ASST-positive chronic urticaria, in which down-regulation of plasma IgG anti-FcεRI and basophil FcεRI may be involved.
This study was desiged to analyze the clinical efficacy of autologous whole blood injection(AWBI)on plasma IgG anti-FcεRI, total IgE, basophil FcεRI receptor expression in ASST-positive chronic spontaneous urticaria(CSU). Total of 80 patients with ASST+CSU were recruited and randomly divided into AWBI group and control group, with 40 cases in each group. Second-generation H1-antihistamines were given to all the patients,while patients in AWBI group were also injected with autologous whole blood once a week for 12 times. Patients were evaluated by urticaria activity score(UAS) before and after treatment; the levels of plasma IgG-anti-FcεRI,total IgE and basophil FcεRIα expression were measured by ELISA or flow cytometry before and after treatment. In addition, healthy volunteers(n=25) were collected as healthy control group. Data showed that after treatment, the notable effective rate of AWBI group was 60%(24/40), which was markedly higher than that of the control group(27.27%, 9/40). Levels of plasma IgG anti-Fc εRI and basophils FcεRIα in ASST+patients after AWBI were significantly lower than that before AWBI, but no significant difference observed in total IgE. The baseline levels of IgG anti-FcεRI, total IgE and basophil FcεRIα were positively correlated with UAS variation in varying degrees. Results in this study demonstrate marked therapeutic effect of autologous whole blood injection in patients with ASST-positive chronic urticaria, in which down-regulation of plasma IgG anti-FcεRI and basophil FcεRI may be involved.
引文
[1]Zuberbier T,Aberer W,Asero R,et al.The EAACI/GA2LEN/EDF/WAO guideline for the definition,classification,diagnosis and management of urticaria[J].Allergy,2018,73(7):1393-1414.
[2]Kolkhir P,Church MK,Weller K,et al.Autoimmune chronic spontaneous urticaria:What we know and what we do not know[J].J Allergy Clin Immunol,2017,139(6):1772-1781.
[3]李时飞,陈奇权,周舟,等.倍增浓度的依巴斯汀有效抑制肥大细胞脱颗粒及细胞因子释放[J].免疫学杂志,2018,34(3):220-224.
[4]宋志强,陈曙光,翟志芳,等.自体全血注射治疗对自体血清皮肤试验阳性的慢性自发性荨麻疹的疗效观察[J].中华皮肤科杂志,2012,45(7):470-473.
[5]Kitsioulis NA,Xepapadaki P,Roussaki-Schulze A,et al.Effectiveness of autologous whole-blood injections in patients with refractory chronic spontaneous urticaria[J].Int Arch Allergy Immunol,2017,172(3):161-166.
[6]You HS,Cho HH,Kim WJ,et al.Autologous whole blood injection for the treatment of antihistamine-resistant chronic spontaneous urticaria[J].Ann Dermatol,2015,27(6):784-786.
[7]Chen Q,Zhai Z,Xu J,et al.Basophil CD63 expression in chronic spontaneous urticaria:Correlation with allergic sensitization,serum autoreactivity and basophil reactivity[J].J Eur Acad Dermatol Venereol,2017,31(3):463-468.
[8]Deza G,Bertolín Colilla M,Pujol R,et al.Basophil FcεRIexpression in chronic spontaneous urticaria:A potential immunological predictor of response to omalizumab therapy[J].Acta Derm Venerol,2017,97(6):698-704.
[9]Schmetzer O,Lakin E,Topal FA,et al.IL-24 is a common and specific autoantigen of IgE in patients with chronic spontaneous urticaria[J].J Allergy Clin Immunol,2018,142(3):876-882.
[10]Altrichter S,Hawro T,Liedtke M,et al.In chronic spontaneous urticaria,IgE against staphylococcal enterotoxins is common and functional[J].Allergy,2018,73(7):1497-1504.
[11]Sun L,Erxun K,Li J,et al.Correlations between anti-mast cell autoantibodies and chronic idiopathic urticaria[J].Ann Dermatol,2014,26(2):145-149.
[12]Smodis NC,Silar M,Erzen R,et al.Down-regulation of FcεRI-mediated CD63 basophil response during shortterm VIT determined venom-nonspecific desensitization[J].PLoS One,2014,9(4):e94762.
[13]Konstantinou GN,Asero R,Ferrer M,et al.EAACItaskforce position paper:Evidence for autoimmune urticaria and proposal for defining diagnostic criteria[J].Allergy,2013,68(1):27-36.
[14]Greer AM,Wu N,Putnam AL,et al.Serum IgE clearance is facilitated by human FcεRI internalization[J].J Clin Invest,2014,124(3):1187-1198.
[2]Kolkhir P,Church MK,Weller K,et al.Autoimmune chronic spontaneous urticaria:What we know and what we do not know[J].J Allergy Clin Immunol,2017,139(6):1772-1781.
[3]李时飞,陈奇权,周舟,等.倍增浓度的依巴斯汀有效抑制肥大细胞脱颗粒及细胞因子释放[J].免疫学杂志,2018,34(3):220-224.
[4]宋志强,陈曙光,翟志芳,等.自体全血注射治疗对自体血清皮肤试验阳性的慢性自发性荨麻疹的疗效观察[J].中华皮肤科杂志,2012,45(7):470-473.
[5]Kitsioulis NA,Xepapadaki P,Roussaki-Schulze A,et al.Effectiveness of autologous whole-blood injections in patients with refractory chronic spontaneous urticaria[J].Int Arch Allergy Immunol,2017,172(3):161-166.
[6]You HS,Cho HH,Kim WJ,et al.Autologous whole blood injection for the treatment of antihistamine-resistant chronic spontaneous urticaria[J].Ann Dermatol,2015,27(6):784-786.
[7]Chen Q,Zhai Z,Xu J,et al.Basophil CD63 expression in chronic spontaneous urticaria:Correlation with allergic sensitization,serum autoreactivity and basophil reactivity[J].J Eur Acad Dermatol Venereol,2017,31(3):463-468.
[8]Deza G,Bertolín Colilla M,Pujol R,et al.Basophil FcεRIexpression in chronic spontaneous urticaria:A potential immunological predictor of response to omalizumab therapy[J].Acta Derm Venerol,2017,97(6):698-704.
[9]Schmetzer O,Lakin E,Topal FA,et al.IL-24 is a common and specific autoantigen of IgE in patients with chronic spontaneous urticaria[J].J Allergy Clin Immunol,2018,142(3):876-882.
[10]Altrichter S,Hawro T,Liedtke M,et al.In chronic spontaneous urticaria,IgE against staphylococcal enterotoxins is common and functional[J].Allergy,2018,73(7):1497-1504.
[11]Sun L,Erxun K,Li J,et al.Correlations between anti-mast cell autoantibodies and chronic idiopathic urticaria[J].Ann Dermatol,2014,26(2):145-149.
[12]Smodis NC,Silar M,Erzen R,et al.Down-regulation of FcεRI-mediated CD63 basophil response during shortterm VIT determined venom-nonspecific desensitization[J].PLoS One,2014,9(4):e94762.
[13]Konstantinou GN,Asero R,Ferrer M,et al.EAACItaskforce position paper:Evidence for autoimmune urticaria and proposal for defining diagnostic criteria[J].Allergy,2013,68(1):27-36.
[14]Greer AM,Wu N,Putnam AL,et al.Serum IgE clearance is facilitated by human FcεRI internalization[J].J Clin Invest,2014,124(3):1187-1198.