Research on underlying mechanisms of Stevens-Johnson syndrome

1.纳入73例(138只眼)Stevens-Johnson综合征慢性期患者。并发症被归类为角膜、结膜和眼皮并发症，13种并发症被评估，并根据其严重程度从0到3进行分级。最严重的并发症是Vogt栅栏消失(114眼，82.6%)和额肌腺受累(102眼，73.9%)。138只眼中有74只眼(53.6%)视力低于20/200。多元回归分析显示，角膜新生血管、混浊、角化和白内障显著影响对数磨镶率(p&lt；0.0001，p&lt；0.0001，p=0.0142和p=0.0375)。2.检测了40例日本SJS/TEN眼部并发症患者和113例健康日本志愿者的组织相容性抗原基因HLA-A、-B和-C。我们澄清了在日本人中，人类白细胞抗原-A*0206与SJS/TEN合并眼部并发症密切相关。3.日本的单核苷酸多态(JSNP)数据库报道了人类Toll样受体(TLR)3基因的7个SNP，其中3个编码在外显子区域，另外4个编码在内含子区域。对57例伴有眼表并发症的日本SJS/TEN患者和160例健康日本人进行了这7个SNPs分析。SNP、299698T/G、293248A/A、299698T/T等位基因与SJS/TEN密切相关。提示日本人群中TLR3基因的多态性可能与SJS/TEN相关。4.我们发现，不仅来自不同受试者的细菌菌株，而且来自同一受试者的多个眼表部位的细菌菌株也表现出不同的PFGE图谱。这些数据显示了表皮葡萄球菌在健康眼表上的多克隆。

1. We enrolled 73 patients (138 eyes) with Stevens-Johnson syndrome at chronic stage. Complications were categorized as corneal-, conjunctival-, and eyelid complications and 13 components were evaluated and graded on a scale from 0 to 3 according to their severity. The most severe complication components were loss of the palisades of Vogt (114 eyes, 82.6%) and meibomian gland involvement (102 eyes, 73.9%). Visual acuity in 74 of the 138 eyes (53.6 %) was worse than 20/200. Multivariable regression analysis showed that corneal neovascularization, opacification, keratinization, and cataracts significantly affected logMAR (p<0.0001, p<0.0001, p=0.0142, and p=0.0375, respectively). 2. We examined the histocompatibility antigen genes HLA-A,-B, and-C of 40 Japanese SJS/TEN patients with ocular complications and 113 healthy Japanese volunteers. We clarified that HLA-A*0206 is strongly associated with SJS/TEN with ocular complications in the Japanese. 3. The Japanese single-nucleotide-polymorphism (JSNP) database reports 7 polymorphisms consisting of 7 SNPs in the human Toll-like receptor (TLR) 3 gene ; 3 of the 7 SNPs are coded in exon regions, and the other 4 are coded in intron regions. These 7 SNPs were analysed in 57 Japanese patients with SJS/TEN with ocular surface complications and in 160 Japanese healthy controls. SNP 299698T/G and the genotype patterns of 293248A/A and 299698T/T were strongly associated with SJS/TEN. The results suggested that polymorphisms in the TLR3 gene could be associated with SJS/TEN in the Japanese population. 4. We found that bacterial strains not only from different subjects but also from multiple ocular surface sites of the same subject exhibited different PFGE patterns. The data demonstrated the polyclonality of S. epidermidis on the healthy ocular surface.