药疹患者临床特征分析及补体系统异常活化的探讨

于均峰++尚佩生+++张文娟++沈晓峰

[摘要] 目的 了解近年烏鲁木齐市药疹患者的临床特征，检测不同类型药疹患者及健康对照者血清中IgG、IgE、IgA、C3、C4、CIC水平，初步探讨补体系统活化在在药疹发病机制中的作用。 方法 收集2013年12月～2015年12月新疆医科大学第一、第五附属医院皮肤科病房62例药疹患者，包括52例轻型药疹患者（药物性皮炎组）及10例重症药疹患者（重症药疹组），并选择新疆医科大学第五附属医院体检中心健康人群30名作为健康对照组。采集上述药疹患者急性期血清以及对照人群血清，采用酶联免疫吸附试验（ELISA）检测血清中IgG、IgE、IgA、C3、C4、CIC浓度。 结果 引起药疹的致敏药中抗生素所占比例最大，共有32例，约占总数的51.61%；其次为中药注射剂，共有18例，占29.03%。两组药疹患者的血清IgG水平均低于健康对照组（P < 0.05），IgE含量均高于健康对照组（P < 0.05），而且重症药疹组患者入院时IgE水平高于药物性皮炎组（P < 0.05）。药疹患者血清中C3含量低于健康对照组，CIC含量高于健康对照组，而且重症药疹组入院时CIC含量高于药物性皮炎组，差异均有统计学意义（P < 0.05）。 结论 补体系统的异常活化尤其是C3的消耗及CIC的沉积在药疹的发病机制中具有一定意义。

[关键词] 药疹；补体系统；致敏药物

[中图分类号] R758 [文献标识码] A [文章编号] 1673-7210（2017）04（b）-0115-04

[Abstract] Objective To investigate the clinical characters of patient with drug eruption， detect the serum levels of IgG， IgE， IgA， C3， C4 and CIC in the patients and healthy control， preliminary discuss the role of complement system in pathogenesis of drug eruption. Methods 62 patients with drug eruption in Dermatology Wards of the First Affiliated Hospitals of Xinjiang Medical University and the Fifth Affiliated Hospitals of Xinjiang Medical University from December 2013 to December 2015 were selected， including 10 patients with severe drug eruption （severe drug eruption group）， and 52 patients with mild drug eruption （dermatitis medicamentosa group）. At the same time 30 healthy controls in Physical Examination Center of the Fifth Affiliated Hospitals of Xinjiang Medical University were selected as the healthy control group. The serum of acute stage patients and healthy controls were collected. The levels of IgG， IgE， IgA， C3， C4 and CIC in serum were determined by enzyme-linked immunosorbent assay. Results Antibiotics was the main sensitizer in drug eruption， the proportion was 51.61% （32 cases）. The second sensitizer was traditional Chinese medicine preparation， the proportion was 29.03% （18 cases）. Serum levels of IgG in patients with drug eruption were lower than those in the healthy control group （P < 0.05）， while levels of IgE were higher than those in the healthy control group （P < 0.05）， and level of IgE in patients at admission of the severe drug eruption group was higher than that in the dermatitis medicamentosa group （P < 0.05）. The levels of C3 in patients with drug eruption were lower than those in the healthy control group， levels of CIC were higher than those in the healthy control group， and level of CIC in patients at admission of the severe drug eruption group was higher than that in the dermatitis medicamentosa group， with statistically significant differences （P < 0.05）. Conclusion The abnormal activation of complement system especially the consumption of C3 and deposition of CIC may play an important role in the pathogenesis of drug eruption.