2018 年第 5 期 第 13 卷

荨麻疹性血管炎110例临床病理分析

Clinical and histopathological analysis of urticarial vasculitis in 110 patients

作者：王誉涵涂平刘玲玲

英文作者：

单位：100034北京大学第一医院皮肤科

英文单位：

关键词：荨麻疹性血管炎；血管炎；组织病理；临床特点

英文关键词：

• 摘要：

• 目的    分析荨麻疹性血管炎（UV）的临床和组织病理学特征。方法    收集2016年1月至2017年7月北京大学第一医院皮肤科诊断为UV的110例患者的病历资料，对其病理特点进行回顾性分析。并对其中30例反复发作荨麻疹样皮损并且组织病理报告为UV的患者进行临床特征、组织病理学及实验室检查分析。结果    30例UV患者中25例（88.3%）皮损持续时间大于24 h，皮损均表现为水肿性红斑/斑块（100.0%），其中16例（53.3%）消退时呈环状，12例（40.0%）可见色素沉着斑。110例患者组织病理检查显示典型白细胞碎裂性血管炎48例（43.6%），均见真皮血管周围嗜酸性粒细胞浸润（100.0%），嗜中性粒细胞浸润78例（70.9%）。实验室检查显示补体C4降低者3.3%（1/30），抗核抗体阳性30.0%（9/30）；皮损直接免疫荧光检查显示免疫球蛋白（Ig）A、IgG、IgM、补体C3、C4均呈阴性。所有患者（100.0%）均对单用H1抗组胺药加倍剂量和/或联合用药治疗超过4周无效。结论    皮损为水肿性红斑/斑块且持续时间大于24 h、呈环状消退及遗留色素沉着斑，常规抗组胺药物治疗效果不佳可作为临床诊断UV的重要线索；白细胞碎裂性血管炎以及真皮小血管周围出现嗜酸性粒细胞浸润具有病理诊断意义。

• 【Abstract】Objective    To analyze the clinical and histopathological features of urticarial vasculitis(UV). Methods    Records of 110 UA patients from January 2016 to July 2017 in Peking University First Hospital were reviewed. Clinical and pathological features of UA were analyzed. Thirty cases of them diagnosed by histopathological results had laboratory examinations of complements and antibodies. Results    In 30 UV patients diagnosed by histopathological test, skin lesions in 25 cases（88.3%） lasted longer than 24 h; the lesions were characterized as edematous erythematous erythemas/plaques（100.0%）, annular plaques［16 cases（53.3%）］ and pigmentation patches［12 cases（40.0%）］. In 110 UV patients, histopathological test showed 48 cases（43.6%） of typical leukocytoclastic vasculitis; eosinophil infiltration was observed in all lesions（100.0%）; neutrophil infiltration was observed in 78 cases（70.9%）. Laboratory examination showed C4 hypocomplementemia［3.3%（1/30）］ and positive antinuclear antibody［30.0%（9/30）］. Immunofluorescence assay showed negative immunoglobulin（Ig）A, IgG, IgM, complement C3 and C4 in all patients. All patients（100.0%） had no response to H1 antihistamines in more than 4 weeks. Conclusion    UV should be suspected in patients with edematous erythematous erythemas/plaques lasting longer than 24 h, annular plaques and pigmentation patches with no response to antihistamines; leukocytoclastic vasculitis and eosinophil infiltration have pathological diagnostic significances of UV.

  【Key words】Urticarial vasculitis;Vasculitis;Histopathology;Clinical features