Cardoso P A, de Oliveira Z P, Alves V A, Candelori I, Croce J, Rivitti E A
Dermatology Department, São Paulo University, Brazil.
Allergol Immunopathol (Madr). 1990 Jul-Aug;18(4):191-5.
Thirty seven patients with chronic urticaria were prospectively studied from August 1984 to July 1986. These patients were submitted to regular and immunological laboratory tests. Biopsies were taken from recent urticarial lesions for histologic analysis and also to direct immunofluorescence and immunohistochemistry studies. Vasculitis was found in 27% of the patients. Most of them showed only urticarial lesions except two (20%), that presented residual macula; angioedema occurred in 20% of the urticarial vasculitis (UV) patients; most cases had no systemic manifestations. Serum immunoglobulins and circulant immunocomplexes were increased in both groups. Complement reduction was considered an evidence of vascular aggression, being found in 55% of the UV patients. Direct immunofluorescence studies showed only 10% of positive IgM fluorescence in the vessel walls in the UV group. Immunohistochemical evaluation in the same group revealed mainly slight deposition of immunoglobulins IgG, IgM and IgA in the plasma cells of 80% of the samples and in only 10% there was immunoglobulin deposition in the vessel walls. The authors concluded that conventional histopathology is the best diagnosis method for urticarial vasculitis, direct immunofluorescence and immunoperoxidase being ancillary tools. Therefore, a special group of patients was detected, clinically and therapeutically resembling common urticaria patients, but presenting vasculitis in the histologic exam. This fact leads to the hypothesis that there is a range between common urticaria and urticarial vasculitis with systemic involvement.
1984年8月至1986年7月，对37例慢性荨麻疹患者进行了前瞻性研究。这些患者接受了常规和免疫学实验室检查。从近期荨麻疹皮损处取活检组织进行组织学分析，以及直接免疫荧光和免疫组织化学研究。27%的患者发现有血管炎。除2例（20%）出现残留黄斑外，大多数患者仅表现为荨麻疹皮损；20%的荨麻疹性血管炎（UV）患者出现血管性水肿；大多数病例无全身表现。两组患者血清免疫球蛋白和循环免疫复合物均升高。补体降低被认为是血管侵袭的证据，在55%的UV患者中发现。直接免疫荧光研究显示，UV组仅10%的血管壁IgM荧光阳性。同一组的免疫组织化学评估显示，80%的样本浆细胞中主要有免疫球蛋白IgG、IgM和IgA的轻度沉积，仅10%的样本血管壁有免疫球蛋白沉积。作者得出结论，传统组织病理学是诊断荨麻疹性血管炎的最佳方法，直接免疫荧光和免疫过氧化物酶为辅助手段。因此，检测到一组特殊患者，其临床和治疗表现与普通荨麻疹患者相似，但组织学检查显示有血管炎。这一事实引出一个假设，即普通荨麻疹和伴有全身受累的荨麻疹性血管炎之间存在一个范围。
