三氯乙烯药疹样皮炎肝脏自身免疫性指标分析
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摘要
[目的]探索三氯乙烯药疹样皮炎(occupational medicamentosa-like dermatitis induced by trichloroethylene,OMDT)引发的肝脏自身免疫情况。[方法]选取10例OMDT慢性期患者和5名门诊随访的治愈者作为研究对象,检测肝功能指标丙氨酸氨基转移酶(ALT)和自身免疫性肝炎(AIH)相关免疫指标[免疫球蛋白(IgG)、抗核抗体(ANA)、抗平滑肌抗体(ASMA)、抗肝肾微粒体抗体(LKM-1)、抗肝溶质抗原1型抗体(LC-1)、抗可溶性肝抗原/肝胰抗原抗体(SLA/LP)、抗线粒体亚型-2抗体(AMA-M2)],比较、分析各指标在慢性期患者和治愈者中的水平。[结果]慢性期患者肝功能指标ALT活性中位数(49.5 U/L)高于临床参考值,但IgG浓度(4.74～11.32 g/L)均在参考值范围内,且自身抗体指标均为阴性。治愈者ALT活性中位数(10.0 U/L)在参考值范围内,但其中1人(20%)IgG浓度高于临床参考值,ANA阳性率为60%,其他自身抗体指标均为阴性。慢性期患者ALT活性中位数高于治愈者,而治愈者ANA阳性率高于慢性期患者,差异均有统计学意义(P <0.05)。[结论] OMDT患者在慢性期期间虽然肝功能受损,但可能未发生自身免疫;治愈后肝功能基本恢复,部分自身免疫指标却可能升高。
[Objective] This study was to preliminarily analyse manifestation of liver autoimmunity in patients with trichloroethylene-induced medicamentosa-like dermatitis. [Methods] Totally 15 patients,10 cases in chronic phase and 5patients in recovery phase,were analyzed in detail. The liver function indices,such as ALT and autoimmune hepatitis-related indices,including immunoglobulin G(IgG),antinuclear antibody(ANA),anti-smooth-muscle antibody(ASMA),anti-liver-kidney-microsomes antibody(LKM-1),anti-liver-cytosol antigen type 1 antibody(LC-1),anti-soluble-liver antigen/liver-pancreas antigen antibody(SLA/LP)and anti-mitochondrial subtype 2 antibody(AMA-M2)were examined and compared between the patients in chronic phase and recovery phase. [Results] The median of ALT activity of patients in the chronic phase was 49.5U/L,which was higher than the reference value. Their IgG concentrations varied from 4.74-11.32 g/L and were in the scope of reference values,and other autoantibody indices were all negative. The median of ALT activity of patients in recovery phase was10.0 U/L,but one patient had IgG concentration higher than the reference value and 3 cases had positive ANA,while other cases' autoantibody indices were all negative. The ALT activity of patients in the chronic phase patients was higher than that of patients in recovery phase,while the positive rate of ANA in the patients in recovery phase was higher than that of patients in chronic phase(P < 0.05). [Conclusion] Results indicated that patients in chronic phase had damage of liver function but no occurrence of autoimmunity;the patients in recover phase had normal liver function,but some cases had occurrence of the autoimmune indices.
[Objective] This study was to preliminarily analyse manifestation of liver autoimmunity in patients with trichloroethylene-induced medicamentosa-like dermatitis. [Methods] Totally 15 patients,10 cases in chronic phase and 5patients in recovery phase,were analyzed in detail. The liver function indices,such as ALT and autoimmune hepatitis-related indices,including immunoglobulin G(IgG),antinuclear antibody(ANA),anti-smooth-muscle antibody(ASMA),anti-liver-kidney-microsomes antibody(LKM-1),anti-liver-cytosol antigen type 1 antibody(LC-1),anti-soluble-liver antigen/liver-pancreas antigen antibody(SLA/LP)and anti-mitochondrial subtype 2 antibody(AMA-M2)were examined and compared between the patients in chronic phase and recovery phase. [Results] The median of ALT activity of patients in the chronic phase was 49.5U/L,which was higher than the reference value. Their IgG concentrations varied from 4.74-11.32 g/L and were in the scope of reference values,and other autoantibody indices were all negative. The median of ALT activity of patients in recovery phase was10.0 U/L,but one patient had IgG concentration higher than the reference value and 3 cases had positive ANA,while other cases' autoantibody indices were all negative. The ALT activity of patients in the chronic phase patients was higher than that of patients in recovery phase,while the positive rate of ANA in the patients in recovery phase was higher than that of patients in chronic phase(P < 0.05). [Conclusion] Results indicated that patients in chronic phase had damage of liver function but no occurrence of autoimmunity;the patients in recover phase had normal liver function,but some cases had occurrence of the autoimmune indices.
引文
[1] XU X Y,YANG R X,WU N,et al. Severe hypersensitivity dermatitis and liver dysfunction induced by occupational exposure to trichloroethylene[J]. Ind Health,2009,47(2):107-112.
[2] COOPER G S,MAKRIS S L,NIETERT P J,et al. Evidence of autoimmune-related effects of trichloroethylene exposure from studies in mice and humans[J]. Environ Health Perspect,2009,117(5):696-702.
[3]吴奇峰,叶晓光,陈甦生,等.三氯乙烯药疹样皮炎研究概况[J].中国职业医学,2010,37(3):255-256,258.
[4]周丽,徐新云,史才枫,等.三氯乙烯致变态反应作用及对免疫系统影响研究进展[J].中国预防医学杂志,2010,11(8):851-853.
[5]黄永顺,黄汉林.职业性三氯乙烯药疹样皮炎免疫损伤研究进展[J].中国职业医学,2010,37(2):157-159,162.
[6] KAMIJIMA M,HISANAGA N,WANG H,et al. Occupational trichloroethylene exposure as a cause of idiosyncratic generalized skin disorders and accompanying hepatitis similar to drug hypersensitivities[J]. Int Arch Occup Environ Health,2007,80(5):357-370.
[7] ZHANG J X, LI N,WANG H, et al. The immune response in trichloroethylene hypersensitivity syndrome:a review[J]. Toxicol Ind Health,2017,33(11):876-883.
[8]蒋翔,王绮夏,马雄. 2014年自身免疫性肝病诊疗进展[J].实用肝脏病杂志,2015,18(1):15-19.
[9]中华人民共和国卫生部.职业性三氯乙烯药疹样皮炎诊断标准:GBZ185-2006[S].北京:人民卫生出版社,2007.
[10] OO Y H,HUBSCHER S G,ADAMS D H. Autoimmune hepatitis:new paradigms in the pathogenesis,diagnosis,and management[J]. Hepatol Int,2010,4(2):475-493.
[11]王绮夏,马雄.自身免疫性肝炎简化诊断标准的介绍[J].肝脏杂志,2009,14(4):326-327.
[12]朱静,沈伟峰,张黎霞,等.自身免疫性抗体检测在不同肝病中的应用[J].中华医院感染学杂志,2013,23(22):5624-5626.
[13]陈志刚,陈波,杨军,等.汉族与哈萨克族人群血清抗核抗体比较[J].中国公共卫生,2008,24(12):1516-1517.
[2] COOPER G S,MAKRIS S L,NIETERT P J,et al. Evidence of autoimmune-related effects of trichloroethylene exposure from studies in mice and humans[J]. Environ Health Perspect,2009,117(5):696-702.
[3]吴奇峰,叶晓光,陈甦生,等.三氯乙烯药疹样皮炎研究概况[J].中国职业医学,2010,37(3):255-256,258.
[4]周丽,徐新云,史才枫,等.三氯乙烯致变态反应作用及对免疫系统影响研究进展[J].中国预防医学杂志,2010,11(8):851-853.
[5]黄永顺,黄汉林.职业性三氯乙烯药疹样皮炎免疫损伤研究进展[J].中国职业医学,2010,37(2):157-159,162.
[6] KAMIJIMA M,HISANAGA N,WANG H,et al. Occupational trichloroethylene exposure as a cause of idiosyncratic generalized skin disorders and accompanying hepatitis similar to drug hypersensitivities[J]. Int Arch Occup Environ Health,2007,80(5):357-370.
[7] ZHANG J X, LI N,WANG H, et al. The immune response in trichloroethylene hypersensitivity syndrome:a review[J]. Toxicol Ind Health,2017,33(11):876-883.
[8]蒋翔,王绮夏,马雄. 2014年自身免疫性肝病诊疗进展[J].实用肝脏病杂志,2015,18(1):15-19.
[9]中华人民共和国卫生部.职业性三氯乙烯药疹样皮炎诊断标准:GBZ185-2006[S].北京:人民卫生出版社,2007.
[10] OO Y H,HUBSCHER S G,ADAMS D H. Autoimmune hepatitis:new paradigms in the pathogenesis,diagnosis,and management[J]. Hepatol Int,2010,4(2):475-493.
[11]王绮夏,马雄.自身免疫性肝炎简化诊断标准的介绍[J].肝脏杂志,2009,14(4):326-327.
[12]朱静,沈伟峰,张黎霞,等.自身免疫性抗体检测在不同肝病中的应用[J].中华医院感染学杂志,2013,23(22):5624-5626.
[13]陈志刚,陈波,杨军,等.汉族与哈萨克族人群血清抗核抗体比较[J].中国公共卫生,2008,24(12):1516-1517.