| Objectives1.To analyze the clinical characteristics of patients with polymorphous light eruption and provide the basis for the diagnosis,treatment and prevention of recurrence of this disease.2.To study the polymorphism of HLA-DPA1,DPB1 and DRB1 alleles and haplotypes in the Yunnan Han patients with polymorphous light eruption and explore its role in pathogenesis.Methods1.Collected the clinical data of 313 patients with PLE diagnosed in outpatient department and inpatient department of Department of Dermatology,the First.Affiliated Hospital of Kunming Medical University from October 2014 to December 2016.The survey included gender,age,occupation,daily average sunshine time,nationality,place of origin,past history,personal hi story,family history,age of onset,duration,onset or exacerbation of season,location,type and area of skin rash,aggravate the condition factors in addition to the sun,photosensitive test,anti nuclear antibody test,histopathological examination,treatment and prognosis.SPSS software was used to compare the general situation,characteristics of disease and the results of photosensitivity test in patients between different genders.2.Collected the Yunnan Han PLE patients diagnosed in our hospital and Yunnan Han healthy people gave physical examination in our outpatient department from October 2014 to December 2016 each 300 cases as samples.Then draw blood,extract genomic DNA,amplify the HLA-DPA1,DPB1 and DRB1 alleles by PCR-SBT method,make gene sequencing and typing.SPSS software was used to compare the alleles and haplotypes frequencies between the case group and the control group and analyse its correlation with the incidence of PLE.Results1.In 313 patients there were 126 men(40.26%)and 187 women(59.74%),the ratio of man to women was 1:1.5;there was significant difference in the daily average sunshine time between the different gender patients(P<0.05),women mainly in 2-5 hours and men mainly in 5-8 hours;women in the age of onset was from 12 to 76,the average age was 36.43±13.84,mainly in 21-35 years old,and men in the age of onset was from 11 to 71,the average age was 36.80± 12.54,mainly in 36-50 years old,there was no statistically significant difference(P>0.05);the duration of the disease in women was from 3 days to 20 years,with a median of 1 year,and the duration of the disease in men was 1 week to 20 years,with a median of 2 years,the difference was statistically significant(P<0.05);this disease occurred all the year around,mostly in the spring(1112 cases,35.78%)and summer(116 cases,37.06%),there was significant difference between genders(P<0.05);the lesions were mostly distributed in the face and neck(312 cases,99.68%),upper limbs(182 cases,58.15%)and head(88 cases,28.12%);the type of skin rash was mainly papular type(117 cases,37.38%),eczema type(86 cases,27.48%)and edematous erythema type(45 cases,14.38%),there was also remarkably diversity between gender groups;edematous erythema type accounted for 26.74%in the female group,which was significantly higher than that only accounted for 10.32%in the male group(P<0.05),eczema type accounted for 23.53%in female group,which was significantly lower than that accounted for 43.65%in the male group(P<0.05),there was no significant difference in papular,purigo and mixed type(P>0.05);the rash area was mainly from 1%to 5%,and that of male patients was obviously larger than female patients(P<0.05).In 236 patients who made photosensitivity test examination,139 cases were sensitive to UVA,the UVA positive rate was 58.90%,and 151 cases were sensitive to UVB,the UVB positive rate was 63.98%,there was no statistic difference among them(P>0.05),and the sensitivity on UVA and UVB of different sex groups also had no significant difference(P>0.05);all patients underwent antinuclear antibody test,13 cases(4.15%)was ANA positive,11 cases with the relevant examination and long-term follow-up may temporarily exclude autoimmune disease,and other 2 cases were diagnosed with lupus erythematosus and terminate the investigation;the pathologic diagnosis of 46 cases with histopathological examination of skin was nonspecific dermatitis.The treatment mainly includes health education,local and systemic therapy,most patients got better after conventional treatment,among very serious and invalid for these treatment patients,a total of 27(8.63%)took orally glucocorticoids,and 9(2.88%)took orally azathioprine;follow up of 1 week,2 weeks,4 weeks and 8 weeks after the first consultation,145 cases(46.33%)were healed,109 cases(34.82%)were effective,59 cases(18.85%)were improved and 0 cases(0%)was invalid after the systematic standard treatment,the effective rate was 100%.2.The frequencies of HLA-DPAI*02:02:03,DPB1*05:01:01,DPB1*14:01:01,DRB1*08:03:02 alleles and DPA1*02:02:03-DPB1*05:01:01 haplotype were much higher in the PLE case group than the control group,but the frequencies of DPA1*02:01:02,DPA1*02:02:02,DRB1*03:01:01,DRB1*11:01:01,DRB1*12:02:01 alleles and DPA1*02:02:02-DRB1*03:01:01 haplotype were much lower in the PLE case group than the control group(P<0.05).There was no statistically significant three locus haplotype(P>0.05).Conclusions1.Polymorphous light eruption often occurs more in women,young and middle aged people,the exposure position,spring and summer,skin lesions are polymorphic,UVA and UVB are both pathogenic spectrum.There were significant differences in the daily average sunshine time,duration,the onset or exacerbation of season,the type and area of skin rash,but no remarkably diversity in the age of onset and sensitivity to UVA and UVB between patients with the different genders.2.It's inferred that HLA-DPA1*02:02:03,DPB1*05:01:01,DPB1*14:01:01,DRB1*08:03:02 alleles and DPA1*02:02:03-DPB1*05:01:01 haplotype which were positively correlated with the incidence of PLE are possible susceptible genes for PLE,and HLA-DPA1*02:01:02,DPA1*02:02:02,DRB1*03:01:01,DRB1*11:01:01.DRB1*12:02:01 alleles and DPA1*02:02:02-DRB1*03:01:01 haplotype which were negatively correlated with the incidence of PLE are possible protective genes for PLE. |
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