The Study On The Relationship Between The Development Of Trichloroethylene Drug-like Dermatitis And Cytokine

ObjectiveBy describing the developmental characteristics and cytokines in the course of the disease of patients who diagnosed with trichloroethylene drug eruption-like dermatitis?DMLT?,the purpose of the study is to explore the relationship between the developmental characteristics and cytokines,to confirm the role of cytokines in the development of DMLT and to provide clues for the pathogenesis and guidance of clinical medication.MethodsPatients who were diagnosed as occupational trichloroethylene drug rash-like dermatitis from 2013 to 2019 at the Occupational Disease Control Hospital of Guangdong Province were selected in this study.The diagnosis was based on the"Diagnosis Standards for Occupational Trichloroethylene Drug Rash-like Dermatitis"?GBZ185-2006?.The designed"Occupational Health Questionnaire"was used to collect the retrospective information,including basic information,contact history of trichloroethylene?TCE?,medical history,and so on.The medical index such as blood routine,blood biochemistry,and other characteristics was collected from medical record data.Blood specimens?n=6?were harvest from patients on 1^st,2^nd,3^rd,4^th,5^th admission week and the day of hospital discharge.The levels of cytokines IL-5,IL-6,IL-10,IFN-?and TNF-?in blood were measured by enzyme-linked immunosorbent assay?ELISA?.The liver function test was performed at the same time and their correlation with cytokines was analyzed.Results1.Basic information of patientsTwenty-seven patients with DMLT were included in this study,including 19 males and 8 females,whose age ranges from 16 to 40 with a median M-22(P₂₅?P₇₅:18?32).The incubation period of patients ranges from 2 to 66 days,and the median M is 30 days(P₂₅?P₇₅:23?34).The patients largely come from 10 provinces such as Hunan.There is no obvious geographical correlation since the distribution of provinces is scatter.The patients mainly come from electronics factories?44.4%?and are mostly scrub workers?59.2%?.It knows that DMLT contains 4 types of dermatitis and the cases in the study include 20 cases?74.1%?of exfoliative dermatitis,6 cases?22.2%?of erythema erythematosus,and 1case?3.7%?of bullous epidermal necrolysis.At the time of admission,all patients were diagnosed with rash and liver injury,and trichloroacetic acid?TCA?was detected in patients'urine with a maximum concentration of216 mg/L.A few patients had complications such as pulmonary infection and psoriasis when they were admitted to the hospital.Comparing the general conditions of patients with exfoliative dermatitis or non-exfoliative dermatitis when they were hospitalized,the results showed that patients with exfoliative dermatitis?75%?have a higher rate of hepatomegaly than patients with non-exfoliative dermatitis?14.3%?.It also has a higher rate of splenomegaly in exfoliative dermatitis patients?65%?compared with patients with non-ablative dermatitis?14.3%?.These differences were statistically significant?P<0.05?.2.Test results of disease development characteristic indicators2.1 Blood routine:The blood routine of different dermatitis patients was tested,and the results are as follow:The count of white blood cells?WBC?of patients with exfoliative dermatitis significantly increases in the early phase of the disease,and with a maximum concentration of 28?10^9/L?.In some patients,the index of red blood cells?RBC?,hemoglobin?HGB?and hematocrit?HCT?significantly decreased in the early phase of the disease,while the index of PLT has been in obvious fluctuations.The count of WBC increased in the early phase of the disease,reaching a maximum concentration of 25?10^9/L?in patients with erythema erythematosus.The count of WBC in patients with bullous epidermal necrolysis increased mainly in the middle and late phase of the disease,with a maximum concentration of 15?10^9/L?,and the platelet count?PLT?fluctuates within the normal range.2.2 Liver function:The liver function of different dermatitis patients was tested,and the results are as follow:The trend of glutamate aminotransferase?ALT?,aspartate transminase?AST?,total bilirubin?TBil?,direct bilirubin?DBil?,indirect bilirubin?IBil?,total bile acid?TBA?,glutamyl transpeptidase?GGT?is similar in patients with exfoliative dermatitis,and these indexes rise rapidly at the beginning of the disease.It has been observed that a few patients ALT and AST tend to increase again during the recovery period,and total protein?TP?and albumin?ALB?decreased significantly in the early phase of the disease.The index of ALT,AST and GGT increased significantly in patients with erythema multiforme at the beginning of the disease.The index of TBil,DBil,IBil and TBA in half of the patients with erythema multiforme increased less than that of patients with exfoliative dermatitis.The index of TP declines in the early phase of the disease.ALT increased during the middle phase of the disease in patients with bullous epidermal necrolysis,and the rising range was smaller than that of patients with exfoliative dermatitis and erythema multiforme.2.3 Renal function:The renal function of different dermatitis patients was tested,and the results are as follow:Glucose?GLU?increases at the beginning of the disease in patients with exfoliative dermatitis,ranging to the maximum concentration-20?mmol/L?,and GLU in a few patients increase again during the recovery period;It has been observed that uric acid?UA?increase significantly in the later phase of the disease,and that GLU increased in patients with erythema multiforme in the early phase of the disease,ranging to the maximum concentration-15?mmol/L?.UA increases in the late phase of the disease and creatinine?CREA?increased in the early phase of the disease,GLU in patients with bullous epidermal necrolysis increased in the early phase of the disease,ranging to the maximum concentration-10?mmol/L?.2.4 Lipid index:The lipid index of different dermatitis patients was tested,and the results are as follow:It has been observed that triglyceride?TG?increased in the early phases of the disease in patients with exfoliative dermatitis,ranging to the maximum value of 7?mmol/L?.The index of total cholesterol?CHOL?,high-density lipoprotein?HDLC?,low-density lipoprotein?LDLC?and apolipoprotein A1?ApoA1?was first decreases and then rises to normal levels during the pathogenesis process.Apolipoprotein B?ApoB?shows jagged fluctuations above the normal level.TG increased at the beginning of the disease in patients with erythema erythematosus and bullous epidermal necrolysis,and the maximum concentration was 4?mmol/L?.CHOL,HDLC and ApoA1 were first decreased and then increased to normal during the pathogenesis process.2.5 Heart kinase:The heart kinase of different dermatitis patients was tested,and the results are as follow:The index of phosphocreatine kinase?CK?,phosphocreatine kinase isoenzyme MB?CKMB?,lactate dehydrogenase?LDH?and hydroxyb-utyrate dehydrogenase?HBDH?in patients with exfoliative dermatitis increase largely and produce long-lasting;Cholinesterase?CHE?was first decreases and then increases in the process of the disease.The increment and lasting-time of LDH and HBDH in the early phase of the disease in patients with erythema multiforme are less than that of other patients.LDH and HBDH increased during the middle and late phases of the disease in patients with bullous epidermal necrolysis.2.6 Immune function:The immune function of different dermatitis patients was tested,and the results are as follow:Immunoglobulin A?lgA?and immunoglobulin M?lgM?increased slightly at the beginning of the disease in patients with exfoliative dermatitis;C-reactive protein?CRP?showed jagged fluctuations above the normal range and produce a long duration;The level of complement 4?C4?and complement 3?C3?decreased in the early phase of the disease.lgA and lgM increased slightly at the beginning of the disease in patients with exfoliative dermatitis and bullous epidermal necrolysis;CRP showed jagged fluctuations above the normal range and produce a short duration.3.Cytokine test resultsThe cytokine in different dermatitis patients was tested,and the results are as follow:In the early phase of exfoliative dermatitis,the cytokines TNF-?,IL-5,IL-6 and IL-10 are increased and the increment is large and long-lasting;IFN-?,IL-6 and IL-10 are predominantly increased in patients with erythema multiforme and such increment is less than exfoliative dermatitis,producing a short duration.TNF-?,IFN-?,IL-6 and IL-10 in Bullous epidermolysis patients are predominantly increased,and the increment is rapid and short-during.Comparing the level of cytokine in different dermatitis patients,the results are as follow:The characteristic of cytokines in different rash types is consistent with their disease characteristics.The level of TNF-?and IL-10 in patients with different dermatitis is higher than that level at the recovery period,and the synergistic changes of these cytokines were similar.The proportion of cytokine in patients with exfoliative dermatitis and bullous epidermal necrolysis is more than patients with erythema multiforme;There is some strong correlation in cytokines IFN-?,IL-10,TNF-?and IL-6 during different pathogenesis processes.4.The relationship between characteristics of the disease development and cytokines4.1 Speraman correlation between blood routine and cytokinesThe blood routine of patients with different dermatitis was analyzed,so as to evaluate the relationship between cytokines and the development of the disease,and the results are as follow:TNF-?,INF-?,IL-10 and IL-6are negatively correlated with HGB and HCT?r_S=-0.381?-0.560?in 1^stt week;TNF-?is negatively correlated with RBC,HGB and HCT?r_S=-0.452?-0.548?in 2^nd week,IL-10 is negatively correlated with RBC?r_S=-0.446?in 2^nd week;TNF-?and IL-10 are negatively correlated with HGB and HCT?r _S=-0.429?-0.514?in 3^rdd week;TNF-?is negatively correlated with WBC and HCT?r_S=-0.459?-0.515?in 4^th week,IL-10 is negatively correlated with RBC,HGB and HCT?r_S=-0.417?-0.628?in 4^thh week;TNF-?is negatively correlated with HCT?r_S=-0.439?in 5^th week,IL-10 is negatively correlated with WBC,RBC,HGB and HCT?r_S=-0.404?-0.567?in 5^th week.The above correlations have statistical differences?P<0.05?.4.2 Speraman correlation between liver function and cytokinesThe liver function of patients with different dermatitis was analyzed,so as to evaluate the relationship between cytokines and the development of the disease,and the results are as follow:IL-10 is positively correlated with TBil,DBil and IBil?r_S=0.405?0.454?in 1^st week;TNF-?is negatively correlated with TP and ALB?r_S=-0.414?-0.487?in 2^nd week,TNF-?is positively correlated with TBil and DBil?r_S=0.374?0.387?in 2^nd week;TNF-?is positively correlated with AST,TBil,DBil,IBil and GGT?r_S=0.399?0.526?in 3^rdd week,IL-10 is positively correlated with TBil,DBil and GGT?r_S=0.381?0.486?in 3^rdd week;TNF-?is positively correlated with ALT,AST,TBil,DBil and IBil?r_S=0.393?0.561?in 4^th week,IL-10is positively correlated with ALT and TBA?r_S=0.399?0.423?in 4^th week;TNF-?is positively correlated with AST,TBil,DBil and GGT?r_S=0.404?0.496?in 5^th week.The above correlations have statistical differences?P<0.05?.4.3 Speraman correlation between renal function and cytokinesThe renal function of patients with different dermatitis was analyzed,so as to evaluate the relationship between cytokines and the development of the disease,and the results are as follow:TNF-?is negatively correlated with BUN?r_S=-0.382?in 1^st week,IL-10 is negatively correlated with CREA?r_S=-0.405?in 1^st week;TNF-?,IL-10 and IL-5 are negatively correlated with CREA?r_S=-0.409?-0.424?in 2^nd week;TNF-?and IL-6are negatively correlated with CREA?r_S=-0.445?-0.499?in 3^rdd week;IL-10 and IL-6 are positively correlated with GLU?r _S=0.422?0.446?in 4^thh week;IL-10 and IL-6 are negatively correlated with CREA?r_S=-0.453?-0.507?in 5^th week.The above correlations have statistical differences?P<0.05?.4.4 Speraman correlation between lipid index and cytokinesThe lipid index of patients with different dermatitis was analyzed,so as to evaluate the relationship between cytokines and the development of the disease,and the results are as follow:TNF-?is negatively correlated with ApoA1?r_S=-0.405?in 1^st week,IL-10 is negatively correlated with ApoA1?r_S=-0.452?in 1^st week;TNF-?and IL-5 are negatively correlated with HDLC and ApoA1?r_S=-0.407?-0.512?in 2^nd week;TNF-?is positively correlated with TG?r _S=0.445?in 3^rdd week,TNF-?is negatively correlated with HDLC and ApoA1?r_S=-0.508?-0.592?in 3^rdd week,IL-10is negatively correlated with HDLC?r_S=-0.409?in 3^rdd week;TNF-?is negatively correlated with HDLC and ApoA1?r_S=-0.593?-0.666?in 4^thh week,IL-10 and IL-6 are positively correlated with TG?r_S=r _S=0.431?0.432?in 4^th week;TNF-?and IL-6 are negatively correlated with HDLC and ApoA1?r_S=-0.439?-0.467?in 5^th week.The above correlations have statistical differences?P<0.05?.4.5 Speraman correlation between heart kinase and cytokinesThe heart kinase of patients with different dermatitis was analyzed,so as to evaluate the relationship between cytokines and the development of the disease,and the results are as follow:TNF-?is positively correlated with LDH and HBDH?r _S=0.596?0.626?in 1^st week,TNF-?and IL-10 are negatively correlated with CHE?r_S=-0.429?-0.558?in 1^st week;TNF-?and IL-6 are negatively correlated with CHE?r_S=-0.451?-0.595?in 2ⁿdd week;TNF-?and IL-10 are negatively correlated with CHE?r_S=-0.520?-0.541?in 3^rdd week;INF-?is positively correlated with HDLC?r_S=0.453?in 4^th week;TNFA-?,IL-10 and IL-6 are negatively correlated with CHE?r_S=-0.466?-0.554?in 5^th week.The above correlations have statistical differences?P<0.05?.4.6 Speraman correlation between immune function and cytokinesThe immune function of patients with different dermatitis was analyzed,so as to evaluate the relationship between cytokines and the development of the disease,and the results are as follow:INF-?and IL-10are negatively correlated with C4?r_S=-0.394?-0.415?in 1^st week;IL-10 is positively correlated with lgG?r _S=0.458?in 2^nd week;TNF-?is negatively correlated with C3 and C4?r_S=-0.426?-0.549?in 3^rdd week,IL-10 is negatively correlated with CRP and C4?r_S=-0.405?-0.414?in 3^rdd week;TNF-?and IL-6 are positively correlated with CRP?r_S=0.419?0.631?in4^th week;IL-10 is positively correlated with lgG?r _S=0.474?in 5^th week.The above correlations have statistical differences?P<0.05?.Conclusion1?DMLT patients accompanied by injury of liver,kidney,heart and other organs were observed in this study.2?DMLT causes abnormal index of blood routine,blood lipid,and immune function.3?The pathogenesis of DMLT is related to both of the cellular immunity and humoral immunity.4?The cytokines IFN-?,TNF-?,IL-6,IL-10 and IL-5 were significantly increased in the pathogenesis of DMLT patients.5?The cytokines TNF-?,IL-10 have a certain degree of correlation with the severity of the patient's condition.