The Relationship Between The Severity Of Chronic Spontaneous Urticaria And D-Dimer,C2a,IL-23 Levels

Background and Objective : To explore the correlation between chronic spontaneous urticaria and the levels of D-dimer,IL-23 and C2a,to analyze the correlation between these three factors on and severity of the disease,and to explore whether these three factors can be used as laboratory indicators to evaluate the severity of chronic spontaneous urticaria,so as to explore the role of coagulation,fibrinolysis and complement systems in the pathogenesis of CSU.Methods:Forty-three patients with chronic spontaneous urticaria diagnosed in the Department of Dermatology of Taizhou People Hospital from April 2022 to October 2022 were collected,including 16 males(37%)and 27 females(63%),aged(39.6±13.7)years.At the same time,a total of 30 healthy people were enrolled as the control group,aged(32.0±10.2)years old,including 15 males(50%)and 15 females(50%).Patients were assessed for disease severity using the urticaria activity score(UAS),which included the total UAS score(24-hour wheal number score and 24-hour pruritus severity score,the sum of the two)and the 7-day urticaria activity score(UAS7).ELISA was used to detect the levels of D-dimer,complement C2a,and interleukin-23(IL-23).Mann-whitney rank sum test was used to analyze the differences in D-dimer,C2a,and IL-23 levels between the CSU group and the healthy group.Kruskal Wallis test was used to analyze the correlation between UAS score,pruritus severity score,wheal number score within 24 hours,UAS7 total score and D-dimer,C2a,and IL-23 levels.The patients were divided into mild and moderate to severe CSU according to UAS score.The diagnostic value of serum D-dimer,C2a and IL-23 for moderate to severe CSU was analyzed by ROC curve.Result:1.In the CSU group,the average UAS score on the first day was 4.0±1.4,and the median UAS score was 4,including 7 patients(16.2%)with 1-2 points,22 patients(51.3%)with 3-4 points,and 14 patients(32.5%)with 5-6 points.The average score of UAS7 was 9.6±6.3,and the median score was 7.Among them,17 patients(39.53%)scored 0-6(low CSU activity),25 patients(58.14%)scored 7-28(moderate CSU activity),and 1 patient(2.33%)scored 29-42(high CSU activity).2.The level of serum D-dimer in the CSU group [459.87(365.56-582.45)] ng/m L was significantly higher than that in the control group [370.46(355.78-456.47)] ng/m L,the difference was statistically significant(Z=-2.237,P<0.05).The serum C2a level in the CSU group [162.77(145.80-179.02)] ng/m L was significantly higher than that in the healthy group [148.82(110.73-164.31)] ng/m L,and the difference was statistically significant(Z=-2.157,P<0.05).The level of IL-23 in the CSU group was [51.83(39.45-58.53)] pg/m L,which was significantly higher than that in the healthy group [41.37(31.28-51.29)] pg/m L,and the difference was statistically significant(Z=-1.979,P<0.05).3.The level of serum D-dimer was positively correlated with IL-23 in patients with CSU(r=0.554,P<0.05).There was a significant positive correlation between serum Ddimer and C2a level(r=0.777,P<0.05).Serum IL-23 level was positively correlated with C2a level(r=0.531,P<0.05).4.The levels of D-dimer,C2a and IL-23 in the CSU group were significantly positively correlated with UAS score(r=0.793,P<0.05;r=0.761,P<0.05;r=0.699,P<0.05).5.The levels of D-dimer,C2a and IL-23 in the CSU group were positively correlated with UAS7 score(r=0.606,P<0.05;r=0.612,P<0.05;r=0.595,P<0.05).6.The AUC of serum D-dimer,C2a,and IL-23 in evaluating UAS score in patients with moderate to severe CSU were 0.873,0.877,and 0.855,respectively.The sensitivity were 91.7%,94.4%,94.4%;The specificity was 85.7%,71.4% and 85.7%,respectively.7.The AUC of serum D-dimer,C2a,and IL-23 in evaluating the total score of UAS7 in patients with moderate to severe CSU were 0.825,0.788,and 0.799,respectively.The sensitivity were 65.4%,65.4%,57.7%;The specificity was 100%,100% and 94.1,respectively.Conclusion:1.The levels of serum D-dimer,C2a,and IL-23 are correlated with the severity of CSU,suggesting that coagulation and fibrinolysis system,complement system,and inflammatory factors may be involved in the progression of CSU and interact with each other.2.The diagnostic efficacy of complement C2a for moderate to severe CSU is high,which can be used to evaluate the severity of CSU,and is expected to be an indicator for the evaluation of the therapeutic effect and a target for the treatment of CSU.