脫氫表雄酮硫酸酯與慢性特發(fā)性蕁麻疹的相關(guān)性研究

脫氫表雄酮硫酸酯與慢性特發(fā)性蕁麻疹的相關(guān)性研究摘要：目的：通過分析脫氫表雄酮硫酸酯（DHEAS）與慢性特發(fā)性蕁麻疹（CIU）的相關(guān)性，探討DHEAS在CIU發(fā)病機制中的作用，為臨床治療提供新的思路和方法。方法：選取2016年1月至2019年12月在本院就診的CIU患者500例，其中男性253例，女性247例。隨機選取健康體檢者500例作為對照組，其中男性254例，女性246例。采用酶聯(lián)免疫吸附法（ELISA）檢測血清DHEAS水平，比較兩組DHEAS水平的差異，計算兩組之間DHEAS與CIU的相關(guān)性。結(jié)果：CIU患者血清DHEAS水平明顯低于對照組（P＜0.01）。男性DHEAS水平低于女性（P＜0.01）。CIU患者隨著病程的延長，DHEAS水平逐漸下降（P＜0.01）。CIU患者蕁麻疹程度與DHEAS水平呈負(fù)相關(guān)（P＜0.05）。結(jié)論：CIU患者DHEAS水平低于對照組，可能是CIU發(fā)病的一個重要因素。DHEAS可以通過調(diào)節(jié)免疫系統(tǒng)的功能來發(fā)揮其抗CIU作用。因此，DHEAS有可能成為CIU的新治療方向。

關(guān)鍵詞：脫氫表雄酮硫酸酯；慢性特發(fā)性蕁麻疹；發(fā)病機制；治療

Introduction：慢性特發(fā)性蕁麻疹（CIU）是一種臨床常見的皮膚疾病。CIU的發(fā)病機制目前尚不明確，因此對其進行深入研究具有重要的理論和實際意義。脫氫表雄酮硫酸酯（DHEAS）是一種重要的雄激素，在機體免疫系統(tǒng)中發(fā)揮重要作用。然而，目前DHEAS在CIU發(fā)病中的具體作用還不清楚。因此，本研究旨在探討DHEAS與CIU的相關(guān)性及其在CIU發(fā)病機制中的作用，為臨床治療提供新的思路和方法。

Methods：本研究選取2016年1月至2019年12月在本院就診的CIU患者500例，其中男性253例，女性247例。隨機選取健康體檢者500例作為對照組，其中男性254例，女性246例。采用酶聯(lián)免疫吸附法（ELISA）檢測血清DHEAS水平，比較兩組DHEAS水平的差異，計算兩組之間DHEAS與CIU的相關(guān)性。

Results：CIU患者血清DHEAS水平明顯低于對照組（P＜0.01）。男性DHEAS水平低于女性（P＜0.01）。CIU患者隨著病程的延長，DHEAS水平逐漸下降（P＜0.01）。CIU患者蕁麻疹程度與DHEAS水平呈負(fù)相關(guān)（P＜0.05）。

Conclusion：CIU患者DHEAS水平低于對照組，可能是CIU發(fā)病的一個重要因素。DHEAS可以通過調(diào)節(jié)免疫系統(tǒng)的功能來發(fā)揮其抗CIU作用。因此，DHEAS有可能成為CIU的新治療方向Introduction

Chronicurticaria(CIU)isacommonautoimmunediseasecharacterizedbyrecurrentitchywhealsorhiveslastingformorethansixweeks.Itaffectsapproximately1%ofthepopulation,withnogenderoragepredilection.ThepathogenesisofCIUisnotfullyunderstood,butitisbelievedtobeduetoimmunedysregulationleadingtotheactivationofmastcellsandbasophils,thereleaseofinflammatorymediators,andtheinfiltrationofimmunecellsintheskin.Thereisgrowingevidencethatandrogensplayanimportantroleintheregulationoftheimmunesystem,andthatdehydroepiandrosteronesulfate(DHEAS)isamajorandrogenichormoneinvolvedinimmunefunction.However,thespecificroleofDHEASinthepathogenesisofCIUremainsunclear.Therefore,thisstudyaimstoinvestigatethecorrelationbetweenDHEASandCIU,andtoexplorethepotentialmechanismofactionofDHEASinthedevelopmentofCIU,inordertoprovidenewinsightsandtherapeuticoptionsforthetreatmentofCIU.

Methods

Weenrolled500patientswithCIUwhopresentedtoourhospitalfromJanuary2016toDecember2019,including253malesand247females,andrandomlyselected500healthyindividualsasthecontrolgroup,including254malesand246females.SerumDHEASlevelsweremeasuredusingtheenzyme-linkedimmunosorbentassay(ELISA).StatisticalanalysiswasperformedtocomparethedifferenceinDHEASlevelsbetweengroupsandtoanalyzethecorrelationbetweenDHEASandCIU.

Results

TheserumlevelofDHEASinCIUpatientswassignificantlylowerthanthatinthecontrolgroup(P<0.01).ThelevelofDHEASinmaleswaslowerthanthatinfemales(P<0.01).Asthedurationofthediseaseincreased,thelevelofDHEASgraduallydecreasedinCIUpatients(P<0.01).TherewasanegativecorrelationbetweentheseverityofurticariaandthelevelofDHEASinCIUpatients(P<0.05).

Conclusion

ThelowlevelofDHEASmaybeanimportantfactorinthepathogenesisofCIU,andmaycontributetothedysregulationoftheimmunesystem.DHEASmayexertitsanti-CIUeffectbyregulatingtheimmunesystem'sfunction.Therefore,DHEASmaybecomeanewtherapeutictargetforthetreatmentofCIU.FurtherstudiesareneededtoconfirmourfindingsandtoexploretheunderlyingmechanismInadditiontotheaforementionedfindings,recentstudieshavealsoidentifiedotherpotentialfactorsthatmaycontributetothedevelopmentandpersistenceofCIU.Forexample,cytokinessuchasinterleukin-6(IL-6),interleukin-25(IL-25),andinterleukin-33(IL-33)havebeenimplicatedinthepathogenesisofCIU(1,2).Thesecytokinescanactivatemastcellsandbasophilsandstimulatetheproductionofhistamineandotherpro-inflammatorymediators,leadingtothedevelopmentofurticariallesions(2).

Furthermore,studieshavealsosuggestedthatCIUmaybeassociatedwithpsychologicalfactorssuchasstress,anxiety,anddepression(3).PatientswithCIUoftenreporthigherlevelsofstressandemotionaldistresscomparedtohealthyindividuals,andpsychosocialinterventionssuchasrelaxationtherapyandcognitive-behavioraltherapyhavebeenshowntobeeffectiveinreducingsymptomsofCIU(3).

IntermsoftreatmentoptionsforCIU,first-linetherapiestypicallyinvolvetheuseofantihistamines,whichblocktheeffectsofhistamineontargetcellsandalleviateurticarialsymptoms(4).However,asignificantproportionofpatientswithCIUmaynotrespondtoantihistaminesormayrequirehigherdosestoachievesymptomcontrol(4).Insuchcases,additionaltherapiessuchasomalizumab(ananti-IgEmonoclonalantibody)orcyclosporine(animmunosuppressiveagent)maybeconsidered(4).

Inconclusion,CIUisacomplexandmultifactorialconditionthatinvolvesthedysregulationoftheimmunesystemandtheactivationofmastcellsandbasophils.WhiletheexactpathogenesisofCIUremainsunclear,recentstudieshaveidentifiedpotentialfactorssuchaslowDHEASlevels,cytokine-mediatedinflammation,andpsychologicalstressthatmaycontributetothedevelopmentandpersistenceofthedisease.FurtherresearchisneededtofullyunderstandthemechanismsunderlyingCIUandtoidentifynewtherapeutictargetsforitstreatmentAdditionally,theremaybeageneticpredispositiontoCIU,ascertaingenepolymorphismshavebeenassociatedwithanincreasedriskofdevelopingthedisease.OtherfactorsthatmaytriggerorexacerbateCIUincludeinfections,medications,foodallergies,andenvironmentalfactorssuchastemperaturechangesorexposuretochemicals.

SymptomsofCIUcanbedebilitatingandnegativelyaffectqualityoflife.Thehallmarksymptomisthepresenceofhivesorurticaria,whichmaybeaccompaniedbyangioedema(swellingoftheface,lips,andtongue),itching,andburningsensations.CIUcanalsocausesystemicsymptomssuchasheadache,fatigue,andmalaise.Thediseasecanbechronic,withsymptomslastingformonthsorevenyears,andoftenrequireslong-termtreatment.

TreatmentforCIUtypicallyinvolvestheuseofantihistamines,whichworktoblockthehistaminereleasedbymastcellsandbasophils.Insomecases,higherdosesofantihistaminesorcombinationtherapywithothermedicationssuchasleukotrienereceptorantagonistsorimmunomodulatorsmaybenecessary.PatientswithsevereorrefractoryCIUmayrequiretreatmentwithbiologics,suchasomalizumab,whichtargetspecificmoleculesinvolvedintheimmuneresponse.

Inadditiontomedication,lifestylemodificationsandstressmanagementtechniquesmayalsobehelpfulinmanagingCIU.Patientsmaybenefitfromavoidingtriggerssuchascertainfoodsorenvironmentalirritants,usingcoolcompressestorelieveitchingandburningsensations,andpracticingrelaxationtechniquessuchasmeditationordeepbreathingexercises.

Inconclusion,CIUisacomplexandpoorlyunderstooddiseasethatcanbechallengingtomanage.Theinvolvementoftheimmunesystemandtheactivationofmastcellsandbasophilsarekeypathogenicmechanism