A Preliminary Study Of The Pathological Mechanism And Its Influencing Factors Of Urticaria

OBJECTIVES1. To analyse the clinical characteristics and influencing factors of140patients of urticaria, including62cases of acute urticaria (AU) and78cases of chronic urticaria (CU).2. To detect the number of Tregs and the level of cytokines such as IL-17A, IL-23in patients with chronic urticaria and discuss roles in the pathogenesis of urticaria and its clinical significance.METHODS1. Clinical data of140patients with urticaria in our department of Hangzhou region was reviewed, including the patient’s general condition, induction factors, clinical symptoms, concomitant diseases, laboratory examination, treatment and prognosis, as well as analysis of related factors.2. Flow cytometry to test CD4+CD25+Foxp3+Treg cells in53patients with CU,12patients with AU and30healthy controls was performed, and enzyme-linked immunosorbent method (ELISA) to detect serum concentrations of IL-17A,IL-23in62patients with CU,13patients with AU and37healthy controls was used to compare the date of those three groups. A statistical analysis with SPSS19.0statistical software was used. RESULTS1.140patients with urticaria were composed of52male and88female, the ratio of male to female was2:3, age ranged9-85, mean age was39.31±16.174years old. Incipient age was5-85years old, on an average of37.46±16.658years. The high-risk age was21to60years old (76.4%). No statistical difference in age and the onset of age in AU and CU group was found.55cases of62patients with AU had clear incentives (88.7%), including infection (53cases), drug (14cases) and food (7cases).35cases of78CU patients had suspicious incentives, including climate factors (22cases), food (11cases), infection (8cases) and drug(3cases). On treatment, AU group of16patients adopted oral antihistamines and nonspecific allergy treatment. In46severe patients treated in combination with glucocorticoids (74.2%), symptoms can be controlled after2weeks. These patients were free of diseases in the follow-up period for1month after stopping drugs. While CU group often was required in maintenance treatment with long-term antihistamines, recurrence within1-2days after symptom controlled.2. Peripheral blood CD4+CD25+Foxp3+T cell count in CU, AU and the healthy controls were35.992±28.015%,58.094±32.049%,11.134±15.446%, and the difference was statistically significant (P<0.01). CU group was significantly higher than healthy controls, but lower than the AU group. CD4+CD25+Foxp3+T cell count of patients with abnormal inhaled allergy screening test results were significantly higher than the normal group (P<0.01).3. The level of serum IL-23:CU group, AU group and the healthy controls were80.440±18.333pg/ml,77.054±9.097pg/ml,78.359±18.149pg/ml, there was no significantly statistical difference between the groups. But the level of serum IL-23in those CU who accompanied other diseases was higher than unaccompanied group, the difference was statistically significant (P<0.05). Inhalation allergy screening test in CU showed no significant correlation of serum IL-23with total level of serum IgE,. 4. The level of serum IL-17A in CU, AU and the healthy control group was6.558±4.353pg/ml,9.969±15.446pg/ml,4.791±3.092pg/ml. CU group was higher than the healthy control group, while the AU group was significantly higher than CU group, in which the difference was statistically significant (P<0.01). The level of serum IL-17A in patients accompanying with other diseases was higer than that those with noconcomitant diseases (P<0.05). There is no correlation between level of serum IL-17A, total level of serum IgE and inhalation allergy screening test results in CU patients.CONCLUSION1.88.7%of the AU patients tend to have a definite incentive, mostly for acute infection, drug factors and food factors,critically ill patients needed antihistamines combined with glucocorticoids systematic treatment. The symptoms are usually controlled in2weeks, no relapse. CU group mostly had complex etiology, and more related to climatic factors, food factors, infections and other factors, of which19cases were infected with HP, in which anti-HP treatment could effectively relieve symptoms. Antihistamines needed longer-term maintenance therapy.2. The concentration of IL-17A was measured in62patients with CU and37healthy controls,the level of serum IL-17A in CU patients was significantly higher than that in healthy controls. AU group was significantly higher than the CU group and the differences were statistically significant (P<0.01). The level of serum IL-23and IL-17A in those CU who accompanied other diseases was higher than unaccompanied group, the difference was statistically significant (P<0.05).3. Peripheral blood CD4+CD25+Foxp3+T cell count in CU group was significantly higher than the healthy control group, but lower than the AU group, a significant difference statistically was identified (P<0.01). The level of serum IL-23had no significant implication among CU group, AU group and the healthy controls. The level of serum IL-17A in CU group was higher than that in the healthy control group, but lower than that in the AU group.(P<0.01).4. The counts of peripheral blood CD4+CD25+Foxp3+T cell and the level of serum IL-17A in CU patients were apparently unusual, and related to the body’s immune disorders and Thl/Th2immune imbalance. Tregs and Thl7cells played an important role in the pathogenesis of urticaria.