职业性三氯乙烯药疹样皮炎患者血清体液免疫相关指标分析  

Analysis of serum humoral immunity related indicators in patients with occupational medicamentose-like dermatitis due to trichloroethylene

作　　者：金佳纯[1] 龚雅君 张丽冰 陈铿铿[1] 张骁[1] JIN Jiachun;GONG Yajun;ZHANG Libing;CHEN Kengkeng;ZHANG Xiao(Guangdong Province Hospital for Occupational Disease Prevention and Treatment,Guangzhou,Guangdong 510300,China;不详)

机构地区：[1]广东省职业病防治院,广东广州510300 [2]南方医科大学公共卫生学院,广东广州510300

出　　处：《中国职业医学》2024年第6期645-649,共5页China Occupational Medicine

基　　金：国家自然科学基金(81502769);广东省医学科学技术研究基金(A2020526);广东省职业病防治院重点课题(Z2023-05)。

摘　　要：目的分析不同时期职业性三氯乙烯药疹样皮炎(OMDT)患者血清体液免疫相关指标免疫球蛋白(Ig)、补体和C反应蛋白(CRP)的变化情况。方法采用回顾性分析方法,选择131例OMDT患者为研究对象,收集其发病初期与恢复期肝功能指标和体液免疫相关指标进行分析。结果研究对象发病初期肝功能异常者占89.3%(117/131);其中,轻度、中度、重度肝功能损伤者分别占61.8%、5.3%和22.1%。与恢复期比较,研究对象发病初期血清丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、γ-谷氨酰基转移酶、总胆红素、碱性磷酸酶、总胆汁酸、IgG和CRP水平均升高(P值均<0.01),胆碱酯酶和补体C3水平均下降(P值均<0.01);但发病初期与恢复期的血清白蛋白、球蛋白、IgA、IgM、C4水平和白蛋白/球蛋白比值分别比较,差异均无统计学意义(P值均>0.05)。肝功能重度损伤组患者恢复期血清IgA水平低于同期肝功能轻中度损伤组(P<0.05);肝功能重度损伤患者发病初期血清C3水平低于同时期肝功能轻中度损伤组(P<0.05)。结论OMDT患者发病初期血清IgG和CRP水平升高,C3水平下降,且与肝功能损伤程度有关联;提示体液免疫应答参与了OMDT患者的免疫性肝损伤过程。Objective To analyze the changes of serum humoral immunity related indicators,including immunoglobulins(Ig),complement and C-reactive protein(CRP)in patients with occupational medicamentose-like dermatitis due to trichloroethylene(OMDT)at different stages.Methods A total of 131 OMDT patients were selected as the study subjects using a retrospective analysis method,and liver function and humoral immunity related indicators were collected for analysis in the early stage and the recovery stage of the disease.Results The abnormality of liver function among study subjects was 89.3%(117/131)in the early stage of the disease,with mild,moderate,and severe liver damage accounting for 61.8%,5.3%,and 22.1%,respectively.The levels of serum alanine aminotransferase,aspartate aminotransferase,γ-glutamyl transferase,total bilirubin,alkaline phosphatase,total bile acid,IgG and CRP in the early stage increased(all P<0.01),while the level of serum cholinesterase and C3 decreased(both P<0.01)compared with the recovery stage.However,there was no significant difference in the level of serum albumin,globulin,IgA,IgM and C4 or albumin/globulin ratio between the early stage and the recovery stage(all P>0.05).The level of patients′serum IgA in the group with severe liver function injury was lower than that in the group with mild to moderate liver function injury in the recovery stage(P<0.05).The level of serum C3 in the patients with severe liver function injury was lower than that in the group with mild to moderate liver function injury in the early stage(P<0.05).Conclusion Serum IgG and CRP levels increased and C3 level decreased in OMDT patients at the early stage of the disease,which was correlated with the degree of liver function injury.It is suggested that humoral immune response is involved in the autoimmune liver injury in OMDT patients.

关 键 词：职业性三氯乙烯药疹样皮炎 体液免疫 免疫球蛋白 补体 C反应蛋白 肝功能 肝损伤 

分 类 号：R135.7[医药卫生—劳动卫生]