Lee C-H, Chuang H-Y, Shih C-C, Jong S-B, Chang C-H, Yu H-S
Department of Occupational and Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Br J Dermatol. 2006 Jun;154(6):1100-7. doi: 10.1111/j.1365-2133.2006.07191.x.
Although itch is the predominant symptom of atopic dermatitis (AD), it is poorly characterized and subjective. The objective assessment of itch intensity is important for treatment and follow-up in patients with AD.
To determine what objective clinical parameter(s) could be used as biomarker(s) for itch intensity in patients with AD.
This is a retrospective and cross-sectional study. Seventy-five patients, aged 7 months-49 years with equal sex ratio, were enrolled in 2000 according to criteria proposed by Hanifin and Rajka. Thirty-five age- and sex-matched subjects who visited the dermatological clinic but were otherwise healthy served as controls. Subjective itch intensity was divided into four grades of severity. Disease severity was measured by SCORAD index, which also includes itch intensity as part of the measurement. Transepidermal water loss (TEWL) and skin surface pH were measured by noninvasive methods in clinically normal skin on the forearm. Serum beta-endorphin and vasoactive intestinal peptide (VIP) were determined by radioimmunoassay. Ordinal logistic regression was used to assess the trend of the subjective itch intensity and SCORAD index by serum IgE, beta-endorphin, VIP, TEWL and skin pH.
There were significant trends for itch intensity with IgE, beta-endorphin and TEWL. After adjustment for sex, age and other variables, the odds ratio (OR) for itch intensity by log IgE, beta-endorphin and TEWL was 2.103 [95% confidence interval (CI) 1.222-3.618], 1.100 (95% CI 1.005-1.203) and 1.081 (95% CI 1.009-1.158), respectively. The OR for disease severity by log IgE, beta-endorphin and TEWL was 2.250 (95% CI 1.149-4.407), 1.156 (95% CI 1.086-1.231) and 1.071 (95% CI 0.971-1.182), respectively. In contrast, there was no association between serum VIP concentration and itch intensity.
Beta-endorphin and IgE are both useful biomarkers for itch and disease severity in patients with AD, while TEWL is a good biomarker for itch intensity. These biomarkers provide a way to assess the itch intensity in patients with AD.
尽管瘙痒是特应性皮炎（AD）的主要症状，但其特征描述不足且具有主观性。瘙痒强度的客观评估对于AD患者的治疗和随访很重要。
确定哪些客观临床参数可作为AD患者瘙痒强度的生物标志物。
这是一项回顾性横断面研究。根据Hanifin和Rajka提出的标准，2000年纳入了75例年龄在7个月至49岁之间、男女比例相等的患者。35名年龄和性别匹配、到皮肤科门诊就诊但其他方面健康的受试者作为对照。主观瘙痒强度分为四个严重程度等级。疾病严重程度通过SCORAD指数测量，该指数也将瘙痒强度作为测量的一部分。采用无创方法在前臂临床正常皮肤处测量经表皮水分流失（TEWL）和皮肤表面pH值。通过放射免疫测定法测定血清β-内啡肽和血管活性肠肽（VIP）。采用有序逻辑回归分析血清IgE、β-内啡肽、VIP、TEWL和皮肤pH值与主观瘙痒强度和SCORAD指数的关系。
瘙痒强度与IgE、β-内啡肽和TEWL之间存在显著相关性。在对性别、年龄和其他变量进行校正后，log IgE、β-内啡肽和TEWL导致瘙痒强度的比值比（OR）分别为2.103[95%置信区间（CI）1.222 - 3.618]、1.100（95%CI 1.005 - 1.203）和1.081（95%CI 1.009 - 1.158）。log IgE、β-内啡肽和TEWL导致疾病严重程度的OR分别为2.250（95%CI 1.149 - 4.407）、1.156（95%CI 1.086 - 1.231）和1.071（95%CI 0.971 - 1.182）。相比之下，血清VIP浓度与瘙痒强度之间无关联。
β-内啡肽和IgE均是AD患者瘙痒和疾病严重程度的有用生物标志物，而TEWL是瘙痒强度的良好生物标志物。这些生物标志物为评估AD患者的瘙痒强度提供了一种方法。
