慢性自发型荨麻疹合并结缔组织病患者的临床特点分析

张承中; 黄晨; 刘加; 吉杰; 鲁严

doi:10.16766/j.cnki.issn.1674-4152.003191

慢性自发型荨麻疹合并结缔组织病患者的临床特点分析

doi: 10.16766/j.cnki.issn.1674-4152.003191

南京医科大学第一附属医院皮肤科，江苏南京 210029

基金项目:

国家自然科学基金项目 82203918

江苏省自然科学基金项目 BK20201082

详细信息

通讯作者:
黄晨，E-mail：1711110226@pku.edu.cn

中图分类号: R758.24 R593.2
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出版历程
- 收稿日期: 2023-05-04
- 网络出版日期: 2023-11-23

Clinical and laboratory characteristics of chronic spontaneous urticaria with connective tissue diseases

Department of Dermatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China

摘要

摘要: 目的回顾性分析慢性自发型荨麻疹患者实验室检查的特点以及合并结缔组织病患者自身抗体的特点。方法选取2020年10月—2022年12月就诊于南京医科大学第一附属医院皮肤科的慢性自发型荨麻疹患者400例，对其临床和实验室检查进行分析比较。结果患者中伴有抗甲状腺抗体、抗核抗体阳性的男女比例分别为13.8%(22/160)、18.1%(29/160)，33.3%(80/240)、37.1%(89/240)，合并结缔组织病的患者中，女性40例，男性6例，主要包括类风湿关节炎、干燥综合征、系统性红斑狼疮。女性患者血清特异性IgE抗体、抗甲状腺过氧化物酶抗体(Anti-TPO)、抗甲状腺球蛋白抗体(Anti-Tg)升高的比例均显著高于男性患者(均P < 0.05)。免疫五项中，女性患者IgG、IgM、IgA及补体C3异常的比例显著高于男性患者(均P < 0.05)。女性患者中ANA阳性的比例也显著高于男性患者(P < 0.05)。合并结缔组织病患者的血清特异性IgE抗体、Anti-TPO、Anti-Tg、类风湿因子、红细胞沉降率升高的比例均显著高于不伴有结缔组织病的患者(均P < 0.05)，合并结缔组织病患者的自身抗体阳性率均高于不伴结缔组织病的患者，其中抗核抗体(ANA)、Anti-dsDNA、Anti-Sm、Anti-SSA、Anti-SSB、Anti-Jo-1及Anti-PM-Scl 100阳性率均明显升高(均P < 0.05)。结论慢性自发型荨麻疹患者中部分会伴发结缔组织病，特别是女性患者，因此需要常规对慢性自发型荨麻疹患者进行相关抗体的检测。
- 慢性自发型荨麻疹 /
- 自身抗体 /
- 血清特异性IgE抗体 /
- 结缔组织病
Abstract: Objective To retrospectively evaluate clinical and laboratory characteristics of chronic spontaneous urticaria (CSU) accompanied by connective tissue diseases (CTDs). Methods A total of 400 patients with CSU who were admitted to the Department of Dermatology of the First Affiliated Hospital of Nanjing Medical University from October 2020 to December 2022 were selected. Clinical and laboratory characteristics of CSU in patients with and without CTD were analyzed. Results The male and female proportions of patients with CSU associated with positive Anti-TPO and ANA were 13.8% (22/160), 18.1% (29/160) and 33.3% (80/240), 37.1% (89/240), respectively. Among them, there are 40 female cases and 6 male cases of patients with CTD, mainly including rheumatoid arthritis, Sjogren' s syndrome, and systemic lupus erythematosus. The proportion of serum specific IgE antibody, Anti-TPO and Anti-Tg increased in female patients was significantly higher than that in male patients (all P < 0.05), and the proportion of abnormal levels of IgG, IgM, IgA, complement C3 in five immunological items was significantly higher than that in male patients (all P < 0.05). The proportion of positive ANA in female patients was also significantly higher than that in male patients (P < 0.05). The proportion of serum specific IgE antibody, Anti-TPO, Anti-Tg, RF and ESR increased in patients with connective tissue disease was significantly higher than that in patients without connective tissue disease (all P < 0.05), and the antibody positive rate in patients with connective tissue disease was higher than that in patients without connective tissue disease, there were significant differences in the levels of ANA, Anti-dsDNA, Anti-Sm, Anti-SSA, Anti-SSB, Anti-Jo-1 and Anti-PM-Scl 100 (all P < 0.05). Conclusion The results suggest that CSU is associated with CTDs, especially in female patients. Any patient diagnosed with CSU should be questioned about rheumatic symptoms, and especially in female patients, chronic spontaneous urticaria should be routinely tested for associated antibodies.
- Chronic spontaneous urticaria /
- Autoantibody /
- sIgE /
- Connective tissue diseases

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表 1 不同性别慢性自发型荨麻疹患者观察指标比较

Table 1. Comparison of observational parameters in patients with chronic spontaneous urticaria of different genders

项目	女性(n=240)	男性(n=160)	统计量	P值
年龄(x±s，岁)	41.1±11.0	37.3±11.8	3.331^a	0.001
病程(x±s，月)	15.2±6.0	13.7±7.6	2.218^a	0.027
IgE>60 IU/mL[例(%)]	187(77.9)	94(58.8)	15.580^b	＜0.001
Anti-TPO[例(%)]	80(33.3)	22(13.8)	19.380^b	＜0.001
Anti-Tg[例(%)]	72(30.0)	30(18.8)	6.396^b	0.011
RF≥20 IU/mL[例(%)]	23(9.6)	11(6.9)	0.905^b	0.341
IgG(x±s，g/L)	10.2±1.3	8.1±0.8	18.863^a	＜0.001
IgM(x±s，g/L)	1.2±0.3	1.1±0.2	4.459^a	＜0.001
IgA(x±s，g/L)	0.7±0.2	0.9±0.2	10.078^a	＜0.001
Low C3[例(%)]	45(18.8)	12(7.5)	9.943^b	0.002
Low C4[例(%)]	24(10.0)	9(5.6)	2.428^b	0.119
ESR≥38 mm/h[例(%)]	178(74.2)	86(53.7)	17.833^b	＜0.001
ANA[例(%)]	89(37.1)	29(18.1)	10.836^b	0.001
1/100	51(21.3)	18(11.3)	6.725^b	0.010
1/320	30(12.5)	8(5.0)	6.281^b	0.012
>1/320	8(3.3)	3(1.9)	0.315^b	0.574
CTD[例(%)]	40(16.7)	6(3.8)	15.737^b	＜0.001
RA	20(8.3)	5(3.1)	4.444^b	0.035
SLE	5(2.1)	0	5.150^b	0.023
SS	15(6.3)	1(0.6)	6.908^b	0.009
注：^a为t值，^b为χ²值。

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表 2 合并与不伴有CTD的慢性自发型荨麻疹患者观察指标比较

Table 2. Comparison of observational parameters in patients with chronic spontaneous urticaria, with and without CTD

项目	CSU合并CTD (n=46)	CSU不伴有CTD(n=354)	统计量	P值
性别[例(%)]			15.737^a	＜0.001
女性	40(87.0)	200(56.5)
男性	6(13.0)	154(43.5)
年龄(x±s，岁)	38.9±6.6	39.8±12.3	0.487^b	0.627
病程(x±s，月)	12.6±5.6	15.1±6.8	2.389^b	0.017
IgE>60 IU/mL[例(%)]	42(91.3)	251(70.9)	7.637^a	0.006
Anti-TPO[例(%)]	27(58.7)	43(12.1)	61.098^a	＜0.001
Anti-Tg[例(%)]	24(52.1)	65(18.4)	26.904^a	＜0.001
RF≥20 IU/mL[例(%)]	8(17.4)	26(7.3)	5.283^a	0.022
ESR≥38 mm/h[例(%)]	38(82.6)	235(66.4)	4.945^a	0.026
IgG(x±s，g/L)	9.7±1.1	9.3±1.6	1.645^b	0.101
IgM(x±s，g/L)	1.1±0.2	1.2±0.3	2.197^b	0.029
IgA(x±s，g/L)	0.8±0.2	0.8±0.2	＜0.001^b	0.999
Low C3[例(%)]	15(32.6)	42(11.9)	15.228^a	＜0.001
Low C4[例(%)]	8(17.4)	25(7.1)	5.738^a	0.017
注：^a为χ²值，^b为t值。

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表 3 合并与不伴有CTD的慢性自发型荨麻疹患者自身抗体表达情况比较[例(%)]

Table 3. Comparison of autoantibody expression in patients with chronic spontaneous urticaria, with and without CTD [case (%)]

抗体表达	CSU合并CTD (n=46)	CSU不伴有CTD (n=354)	χ²值	P值
ANA
1/100	23(50.0)	46(13.0)	39.055	＜0.001
1/320	16(34.8)	12(3.4)	61.628	＜0.001
>1/320	7(15.2)	5(1.4)	26.661	＜0.001
Anti-dsDNA	4(8.7)	1(0.3)	17.026	＜0.001
Anti-Sm	2(4.3)	0	8.730	0.003
Anti-SSA(Ro-60)	16(34.8)	3(0.8)	96.255	＜0.001
Anti-SSA(Ro-52)	8(17.4)	5(1.4)	33.057	＜0.001
Anti-SSB	4(8.7)	3(0.8)	10.376	0.001
Anti-centromere B	2(4.3)	3(0.8)	1.703	0.192
Anti-ribosomal P	1(2.2)	1(0.3)	0.360	0.549
Anti-Jo-1	1(2.2)	0	4.345	0.037
Anti-PM-Scl 100	1(2.2)	0	4.345	0.037

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