Deposition of granular IgA relative to clinical lesions in dermatitis herpetiformis.
Deposition of granular IgA relative to clinical lesions in dermatitis herpetiformis.
复制标题
颗粒状 IgA 沉积与疱疹样皮炎临床病变的关系。
DOI：
10.1001/archderm.1996.03890320060010
复制
发表时间：
1996
影响因子：
--
通讯作者：
M. Petersen
中科院分区：
文献类型：
--
作者：
J. Zone;L. Meyer;M. Petersen
目的
比较活动性疱疹样皮炎患者皮肤中与疾病部位相关的伊加和C3沉积。
设计
在1期研究中，皮肤活检标本来自于增生性病灶周围皮肤、非增生性病灶周围皮肤和从未累及的皮肤。在第2阶段研究中，对来自相同解剖区域的非增生性病灶周围和未受累皮肤的样本进行采样。
设置
湖城犹他州大学健康科学中心皮肤科诊所。
患者
已知患有疱疹样皮炎的患者：1期研究中19例患者，2期研究中15例患者。在获得活检标本后48至72小时停止抑制性药物。所有患者在采集活检标本时均患有活动性疾病。
主要观察指标
每个皮肤活检标本的6个切片中伊加和C3免疫荧光染色的强度通过使用半定量量表（0至3+）以盲法由单个观察者进行分级。
结果
19例患者中有11例患者的非炎症皮损周围皮肤伊加沉积比炎症皮损更强烈（P <0.05）。16%（3/19）的红斑皮肤伊加阴性。19例无炎症的病灶周围皮肤中有18例的伊加沉积比无炎症的皮肤更强烈（P <0.01）; C3在有炎症的皮肤中更强烈（P <0.01）。在第二阶段研究中，15名患者中有12名来自同一解剖区域的皮肤在病变附近显示出更大的伊加沉积（P <0.001）。
结论
在疱疹样皮炎患者中，伊加在整个皮肤中分布不均匀，并且伊加在活动性病变附近存在更大量。诊断疱疹样皮炎的首选活检部位是邻近活动性病变的外观正常的皮肤。
OBJECTIVE
To compare the deposition of IgA and C3 in the skin of patients with active dermatitis herpetiformis relative to the sites of disease.
DESIGN
In the phase 1 study, skin biopsy specimens were obtained from erythematous perilesional skin, nonerythematous perilesional skin, and never-involved skin. In the phase 2 study, specimens from the nonerythematous perilesional and uninvolved skin from the same anatomic region were sampled.
SETTING
The Dermatology Clinic at the University of Utah Health Sciences Center, Salt Lake City.
PATIENTS
Patients with known dermatitis herpetiformis: 19 patients in the phase 1 study and 15 patients in the phase 2 study. Suppressive medications were stopped for 48 to 72 hours after biopsy specimens were obtained. All patients had active disease at the time that biopsy specimens were taken.
MAIN OUTCOME MEASURE
The intensity of IgA and C3 immunofluorescent staining in 6 sections from each skin biopsy specimen was graded by using a semiquantitative scale (0 to 3+) in a blinded fashion by a single observer.
RESULTS
Deposition of IgA was more intense in noninflamed perilesional skin in 11 of 19 patients compared with that in erythematous skin (P < .05). Erythematous skin was negative for IgA in 16% (3/19) of the specimens. Noninflamed perilesional skin showed more intense IgA deposition in 18 of 19 specimens compared with that in never-involved skin (P < .01); C3 was more intense in erythematous skin (P < .01). In the phase 2 study, skin from the same anatomic region revealed greater deposition of IgA near lesions in 12 of 15 patients (P < .001).
CONCLUSIONS
In patients with dermatitis herpetiformis, IgA is not uniformly distributed throughout the skin, and IgA is present in greater amounts near active lesions. The preferred biopsy site for the diagnosis of dermatitis herpetiformis is normal-appearing skin that is adjacent to an active lesion.