单核/巨噬细胞及EBV活化在药疹患者中的免疫状况初探  

Study on the immune mechanism of monocyte/macrophage and EBV activation in patients with drug eruption

作　　者：秦宇梁 赵化笛 唐俊婷 QIN Yuliang;ZHAO Huadi;TANG Junting(The First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan)

机构地区：[1]昆明医科大学第一附属医院皮肤科,云南昆明650032

出　　处：《皮肤病与性病》2024年第4期215-221,共7页Dermatology and Venereology

基　　金：云南省科技厅基础研究项目(202101AU070109)。

摘　　要：目的明确不同类型药疹(CDR)单核/巨噬细胞及其相关受体表达情况,明确EBV活化对药疹的影响。方法收集药疹患者和健康对照组,根据其临床表现分为发疹性药疹(MPE)组、重症多形红斑型药疹(SJS)/中毒性大疱表皮松解症(TEN)组、红皮病型药疹(EDE)组和对照组,分析血常规、血生化指标,及单核/巨噬细胞及其受体表达情况。再通过EBV刺激药疹患者及健康对照组外周血单个核细胞,根据EBV是否活化分析单核/巨噬细胞及其受体表达情况,对比分析各组人群的各项检测结果差异。结果本研究发现CDR患者出现巨噬细胞降低,HLA-DR升高;在EDE患者中嗜酸性粒细胞升高,M2/M1偏移,MPE和SJS/TEN患者出现ALT升高,M2/M1轻度偏移甚至不偏移。EBV活化后,CDR患者单核细胞和ALT发生升高,巨噬细胞轻度升高以及M2/M1偏移。结论①HLA-DR升高是药物致敏的评估指标之一;②不同药疹类型其发病机制不同,M2/M1偏移可作为药疹类型评价指标;③单核细胞及ALT升高应高度警惕EBV活化,M2/M1发生偏移是EBV活化的风险指标。Objective To define the expression of monocytes/macrophages and their associated receptors of different types of cutaneous drug reactions(CDR)and to clarify the effect of EBV activation on CDR.Methods Patients with CDR and healthy control group were collected and divided into maculopapular drug eruption(MPE),Stevens-Johnson syndrome(SJS)/toxic epidermal necrolysis(TEN),erythrodermic drug eruption(EDE),and control group according to their clinical manifestations.Blood counts,blood biochemistry,and expression of monocytes/macrophages and their receptors were analyzed.The peripheral blood mononuclear cells of patients with CDR and healthy control group were stimulated by EBV,and the expression of monocytes/macrophages and their receptors were analysed according to whether EBV was activated,and the differences of various detection results among all groups were compared and analyzed.Results The result showed that macrophages decreased and HLA-DR increased in CDR patients;eosinophilic granulocytes increased and M2/M1 shifted in EDE patients,ALT increased and M2/M1 slightly shifted or not shifted in MPE and SJS/TEN patients.After EBV activation,monocytes and ALT were elevated,macrophages slightly elevated,and M2/M1 shifted in CDR patients.Conclusion①Elevation of HLA-DR is one of the indicators of drug sensitization;②The pathogenesis of different CDR types is different,and M2/M1 shift can be used as an indicator of CDR types;③Elevated monocytes and ALT should be highly vigilant against EBV activation,and M2/M1 shift is a risk indicator of EBV activ ation.

关 键 词：药疹 单核细胞 巨噬细胞 EB病毒 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]