O'Donnell B F, Francis D M, Swana G T, Seed P T, Kobza Black A, Greaves M W
St. John's Institute of Dermatology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
Br J Dermatol. 2005 Aug;153(2):331-5. doi: 10.1111/j.1365-2133.2005.06646.x.
Chronic urticaria (CU) is an autoimmune process in some patients. An association between CU and autoimmune thyroid disease has also previously been proposed. Our group has identified functionally significant histamine-releasing autoantibodies in one subset of CU patients (subset 1), predicted by positive autologous intradermal serum tests and positive histamine release from donor basophil leucocytes in vitro. Sera from a second subset of patients (subset 2), all of whom had positive autologous intradermal serum tests, failed to release histamine from donor basophils. A final disease subset (subset 3) has no identifiable skin reactivity (negative autologous serum skin test) or in vitro histamine releasing activity.
In order to examine further the possible relationships between thyroid autoimmunity, thyroid dysfunction and CU, we have examined thyroid autoantibodies and thyroid-stimulating hormone (TSH) levels (an indirect measure of thyroid dysfunction) in the three CU subsets.
PATIENTS/METHODS: We studied 182 patients (69% female), of whom 90 had a positive autologous intradermal serum test.
Eighteen skin test-positive and four skin test-negative patients had thyroid microsomal antibodies (TMA). TSH outside the normal range was found in 13 skin test-positive and one skin test-negative patient. These findings represent clustering of TMA positivity [risk ratio (RR) 4.06, 95% confidence interval (CI) 1.56-10.6] and of abnormal thyroid function (RR 15.5, CI 2.07-11.6) among the skin test-positive patients. However, in the overall study group an elevated TSH was present in seven patients (3.8%, CI 1.6-7.8) comparable to the 5% expected prevalence in the community. Thyroglobulin antibodies (TGA) were present in two of 182 patients.
There were significant differences between skin test-positive and skin test-negative patients with regard to autoimmune thyroid disease. Evidence for autoimmune thyroid disease and abnormal thyroid function was largely found among the skin test-positive patients, supporting the theory of an autoimmune aetiology in this group.
在部分患者中，慢性荨麻疹（CU）是一个自身免疫过程。此前也有人提出慢性荨麻疹与自身免疫性甲状腺疾病之间存在关联。我们的研究团队在一部分慢性荨麻疹患者（第1组）中发现了具有功能意义的组胺释放自身抗体，这通过自体皮内血清试验呈阳性以及供体嗜碱性白细胞在体外释放组胺呈阳性得以预测。第2组患者的血清，所有这些患者的自体皮内血清试验均呈阳性，但未能使供体嗜碱性粒细胞释放组胺。最后一个疾病亚组（第3组）没有可识别的皮肤反应性（自体血清皮肤试验阴性）或体外组胺释放活性。
为了进一步研究甲状腺自身免疫、甲状腺功能障碍与慢性荨麻疹之间可能存在的关系，我们检测了三个慢性荨麻疹亚组中的甲状腺自身抗体和促甲状腺激素（TSH）水平（甲状腺功能障碍的间接指标）。
患者/方法：我们研究了182例患者（69%为女性），其中90例自体皮内血清试验呈阳性。
18例皮肤试验阳性患者和4例皮肤试验阴性患者有甲状腺微粒体抗体（TMA）。在13例皮肤试验阳性患者和1例皮肤试验阴性患者中发现促甲状腺激素超出正常范围。这些发现表明在皮肤试验阳性患者中，TMA阳性（风险比[RR]4.06，95%置信区间[CI]1.56 - 10.6）和甲状腺功能异常（RR 15.5，CI 2.07 - 11.6）出现聚集。然而，在整个研究组中，7例患者（3.8%，CI 1.6 - 7.8）促甲状腺激素升高，与社区预期患病率5%相当。182例患者中有2例存在甲状腺球蛋白抗体（TGA）。
皮肤试验阳性患者和皮肤试验阴性患者在自身免疫性甲状腺疾病方面存在显著差异。自身免疫性甲状腺疾病和甲状腺功能异常的证据主要在皮肤试验阳性患者中发现，支持了该组自身免疫病因学的理论。
