| Background Chronic spontaneous urticaria(CSU)is a mast cell-driven dermatitis characterized by wheal and itching with unknown etiology and a disease duration of more than 6 weeks.The first line of treatment for CSU according to the EAACI/GA2LEN/EDF/WAO urticaria guidelines is a single-dose second-generation antihistamine,but some patients still failed to respond to treatment.The pathophysiological mechanism of CSU is still not completely clear.A number of studies at home and abroad have confirmed the correlation between the pathogenesis of CSU and various inflammatory factors and autoantibodies.Whether CSU patients resistant to single-dose second-generation antihistamines are closely related to these inflammatory factors,autoantibodies and other factors need further exploration.Objective To analyze the possible causes of single-dose second-generation antihistamines in the treatment-resistant of CSU,to explore the possible mechanisms and to propose appropriate solutions.Methods CSU patients who were admitted to our dermatology urticaria clinic from November 2017 to October 2018.Perform blood routine,C-reactive protein,anti-thyroglobulin antibody(TGAb),anti-thyroid peroxidase antibody(TPOAb),Helicobacter pylori antibody(Hp-Ab),total Ig E,autologous serum test(ASST),autologous plasma Test(APST)test.Complete the case questionnaire,urticaria activity score,urticaria quality of life score,and anxiety and depression scores.All patients received oral levocetirizine 5 mg once a night for 2 weeks.Fill the urticaria activity score sheet again after the treatment.According to the curative effect,CSU patients were divided into group A and group B.Group A was a single-dose second-generation antihistamine treatment effective group,and group B was a single-dose second-generation antihistamine treatment-resistant group.The positive rates of routine white blood cell count,CRP,TGAb,TPOAb,hp-ab,total Ig E,ASST and APST were compared between the two groups.And their association with disease duration,urticaria activity score,quality of life score,anxiety and depression score.Then the serum expression levels of IL-6,IL-31,25(OH)D and FcεRI of the two groups of patients and the control group were detected by elisa.The expression levels of serum il-6,il-31,25(OH)D and FcεRI were compared between group A and group B and the control group.And their association with disease duration,urticaria activity score,urticaria quality of life score,anxiety and depression score.Finally,the possible reasons for the difference in the efficacy of single-dose second-generation antihistamines were analyzed,and the possible mechanisms were proposed and appropriate solutions were proposed.Results A total of 110 patients with CSU were enrolled,52 in group A,58 in group B,and 36 in normal controls.1.The urticaria activity score in group A was 4.98±1.11,and that in group B was5.36±0.85.Group B was higher than group A,and the difference was not statistically significant.2.The quality of life score of urticaria in group A was 61.63±19.95,and that in group B was 63.59±18.81.Group B was higher than group A,and the difference was not statistically significant.3.The score of anxiety and depression in group A was 8.43±7.75,and that in group B was 8.45±7.66.The difference between group B and group A was not statistically significant.4.The rate of routine white blood cell elevation in group B(8.62%)was higher than that in group A(5.77%),and the difference was not statistically significant.There was no significant correlation between elevated blood leukocytes and disease duration,urticaria activity score,urticaria quality of life score,and anxiety and depression score.5.The increase rate of CRP in group B(10.34%)was higher than that in group A(7.69%),and the difference was not statistically significant.There was no significant correlation between elevated CRP and duration of disease,urticaria activity score,urticaria quality of life score,and anxiety and depression score.6.The increase rate of TGAb in group B(24.14%)was higher than that in group A(7.69%),and the difference was statistically significant.The increase of TGAb was positively correlated with urticaria activity score,but not with disease course,urticaria quality of life score,anxiety and depression score.7.The increase rate of TPOAb in group B(31.03%)was higher than that in group A(5.77%),and the difference was statistically significant.The increase of TPOAb was positively correlated with urticaria activity score,but not with disease course,urticaria quality of life score,anxiety and depression score.8.The increase rate of Hp-Ab in group B(37.93%)was higher than that in group A(17.31%),and the difference was statistically significant.There was no significant correlation between the elevation of Hp-Ab and disease course,urticaria activity score,urticaria quality of life score,anxiety and depression score.9.The increase rate of total Ig E in group B(31.03%)was higher than that in group A(26.93%),and the difference was not statistically significant.There was no significant correlation between the elevation of total Ig E and disease course,urticaria activity score,urticaria quality of life score,anxiety and depression score.10.The ASST positive rate in group A(69.23%)was higher than that in group B(68.97%),and the difference was not statistically significant.There was no significant correlation between ASST positive and disease course,urticaria activity score,urticaria quality of life score,anxiety and depression score.11.The positive rate of APST in group A(63.46%)was higher than that in group B(58.62%),and the difference was not statistically significant.There was no significant correlation between APST positive and disease course,urticaria activity score,urticaria quality of life score,anxiety and depression score.12.The average level of serum IL-6 levels in group A was 3.94±4.04(pg/m L),6.33±9.48(pg/m L)in group B,and 3.38±2.82(pg/m L)in normal control group.Group A was higher than normal control group.However,the difference was not statistically significant.Group B was higher than the normal control group and the difference was statistically significant.Group B was higher than group A,but the difference was not statistically significant.There was no significant correlation between serum IL-6 levels and disease course,urticaria activity score,quality of life score,anxiety and depression score.13.The average level of serum IL-31 levels in group A was 36.01±57.27(pg/m L),that in group B was 21.58±22.95(pg/m L),and that in normal control group was 10.55±7.69(pg/m L).Group A was higher than normal control group.The difference was statistically significant.Group B was higher than the normal control group and the difference was statistically significant.Group A was higher than group B,but the difference was not statistically significant.There was no significant correlation between serum IL-31 levels and disease course,urticaria activity score,quality of life score,anxiety and depression score.14.The average level of serum 25(OH)D levels in group A was 24.17±7.24(ng/m L),that in group B was 24.85±9.47(ng/m L),and that in normal control group was18.39±4.40(ng/m L).Group A was higher than normal.The difference between the control group and the control group was statistically significant.The difference between the B group and the normal control group was statistically significant.The B group was higher than the A group,but the difference was not statistically significant.There was no significant correlation between serum 25(OH)D levels and disease course,urticaria activity score,quality of life score,anxiety and depression score.15.The average level of serum FcεRI levels in group A was 6.58±12.14(ng/m L),group B was 7.10±12.73(ng/m L),normal control group was 6.97±10.18(ng/m L),and normal control group was higher than A.There was no significant difference in the group,but the difference between the B group and the normal control group was not statistically significant.The B group was higher than the A group,but the difference was not statistically significant.There was no significant correlation between serum FcεRI levels and disease course,urticaria activity score,quality of life score,anxiety and depression score.Conclusion1.Patients with elevated levels of serum TGAb,TPOAb,and Hp-Ab were resistant to single-dose second-generation antihistamine therapy.2.Whether white blood cell count,CRP,and total Ig E increase were not related to the efficacy of single-dose second-generation antihistamines in the treatment of CSU.3.ASST,APST positive or not were independent of the efficacy of single-dose second-generation antihistamines in the treatment of CSU.4.Elevated serum IL-6 levels play an important role in the pathogenesis of single-dose second-generation antibiotics in the CSU-resistant group.Elevated serum IL-6 levels play an important role in the pathogenesis of single-dose second-generation in the treatment-resistant of CSU.5.Elevated serum IL-31 levels play an important role in the pathogenesis of CSU,but not were related to the efficacy of single-dose second-generation antibiotics in the treatment of CSU.6.Whether 25(OH)D,anti-FcεRI autoantibody levels are elevated or not,was independent of the efficacy of single-dose second-generation antihistamines in the treatment of CSU.7.CSU patients with elevated serum TGAb and TPOAb levels have severe wheal and pruritus symptoms. |
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