临床方面,Ferguson[17]等指出,PLE与自身免疫性疾病有关。也有研究发现[18]PLE患者有某种向自身免疫性疾病或甲状腺疾病发展的趋势, 尤其是在女性患者。最近几篇报道指出PLE 与红斑狼疮( lupus erythematosus,LE) 可能有共同的发病机制。Filippa Nyberg[19]调查了337例LE患者,242例有光敏现象,165例有与PLE一致的症状。在LE发病前有PLE 病史的有37例,同时诊断患有两种疾病的患者23例,他们指出PLE在系统性和皮肤型红斑狼疮患者中普遍存在, 二者可共存,其中约50% 患者PLE的发生先于LE,提示两种疾病可能存在共同的发病机制,PLE可能发展为LE。Filippa Nyberg等[19]对65例经过光激发试验的LE和PLE患者皮损进行免疫组化方法研究发现,在皮肤静止的内皮细胞中,VCAM-1和E-选择素呈低水平表达或者不表达,在经过第1w UVA和UVB照射后,在PLE和LE患者群体中,VCAM-1有显著表达,尤其在SLE患者身上,表达的更加强烈,E-选择素在LE患者血管内皮细胞中可能会呈现出高表达。以上研究提示PLE与自身免疫性疾病的免疫发病机制有相关性,同时是多因素的,但还有不少问题有待进一步研究。 2结论与展望 PLE的发病率有逐年上升的趋势,且可能与红斑狼疮等自身免疫性疾病有相关性,好发于面部、颈部、双手和背部等暴露部位,常年反复发作,严重影响患者的容貌及生活质量。对PLE的发病机制的研究,尤其是从免疫学角度的研究已经成为当前热点,虽然目前已取得了一些进展,但仍未阐明,因此,进一步研究PLE与粘附分子的相关性具有重要意义,也将为进一步治疗和预防PLE提供新的思路。 参考文献: [1]HonigsmannH. Polymorphous light eruption[J]. Photodermatol Photoimmunol Photomed, 2008, 24( 3):155-161. [2]MajoieIM, vanWeeldenH, SybesmaIM,et al. Polymorphous light eruption-like skin lesions in welders caused by ultraviolet Clight[J]. J Am Acad Dermatol,2010,62(1) : 150-151. [3]Schmutz JL,Trechot P. Polymorphous light eruption caused by ultraviolet C light [J]. AnnDermatol Venereol,2011, 138( 8-9) : 639. [4]Stratigos AJ, AntoniouC, Katsambas AD.Polymorphous light eruption[J]. J Eur Acad Dermatol Venereol,2002, 16(3) : 193-206. [5]Palme RA, Friedmann PS. Ultraviolet radiation cases less immunosuppression in patients with polymorphous light eruption than in control[J].Invest Dermatology, 2004:122(2):291-294. [6]VerheyenAM,Lambert JR,VanMarckEA,et al. Polymorphic light eruption-an immunopathological study of provoked lesions [J] .ClinExpDermatol,1995,20( 4) : 297-303 [7]Naclerio RM. Pathophysiology of perennial allergic rhinitis[J].Allergy,1997,52:7-13. [8]Lewis RE, Buchsbaum M, Whitaker D. Intercellular adhesion molecule expression in the evolving human cutaneous delayed hypersensitivity reaction[J]. J Invest Dermatol, 1989, 9. [9]Lukaes NW[J].Cell lmmunol, 1999, 154 (1):88. [10]Chuluyan H Eetal[J].J Immunol, 1995, 155(6):672-677.. [11]Janssens AS, Pavel S, Out-Luiting JJ, etal. Normalized ultraviolet ( UV) induction of Langerhans cell depletion and neutrophil infiltrates after artificial UVB hardening of patients with polymorphic light eruption[J]. Br J Dermatol, 2005, 152(6):1268 [12]Haraldsen G, Kvale D, Lien B, et al. Cytokine2regulated expression of E-selectin ,intercellular adhesion-1 (ICAM-1) ,and vascular cell adhesion molecule-1 (VCAM-1) in human intestinal microvascular endothelial cells[J]. J Immunol,1996,156 (7):2558-2563. [13]Geoffrey S ,Kansas GS. Selectins and their ligands :current concepts and controversies[J]. Blood,1996, 88(9):70-73. [14]Shimada Y,Hasegawa M,Takehara A , etal . Elevated serum L2selectin levels and decreased E2selectin expression in systemic sclerosis [J]. Clin Exp Immunol ,2001,124(3):474-479. [15]Wolkerstorfer A, Savelkoul HF, Neijens HJ, etal. Soluble E2selectin and soluble ICAM21 levels as markers of the activity of atopic dermatitisin children[J].Pediatr Allergy Immunol,2003,14(4):302-306. [16]陈颖,陈雯,许国根,等.全身炎症反应综合征血浆E2选择素变化及意义[J].中国急救医学,2005,25(4):89-92. [17]Ferguson PJ, Weinberger M. Shrinking lung syndrome in a 14-year-old boy with systemic lupus erythematosus[J].Pediatr Pulmonol,2006,41:194-197. [18]AubinF,Humbert P. Polymorphic light eruption,skin cancer and immunity [J]. Br JDermatol,2009,161(1) : 191. [19]Nyberg F, Hasan T, Puska P, et al. Occurrence of polymorphous light eruption in lupus erythematosus[J].Br J Dermatol,1997,136:217,221. |