Varghese Rosin, Rajappa Medha, Chandrashekar Laxmisha, Kattimani Shivanand, Archana Mony, Munisamy Malathi, Revathy Gunaseelan, Thappa Devinder Mohan
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Ann Allergy Asthma Immunol. 2016 Apr;116(4):344-348.e1. doi: 10.1016/j.anai.2016.01.016. Epub 2016 Feb 20.
Chronic urticaria (CU) is an immune-mediated disease characterized by wheals for at least 6 weeks. The role of stress and the correlation of stress, hypocortisolism, and inflammatory markers are not well understood.
To estimate C-reactive protein (CRP), interleukin (IL)-18, and cortisol levels in patients with CU and to explore their association with disease severity and stress.
Forty-five patients with CU and 45 age- and sex-matched healthy controls were recruited for this cross-sectional study. Disease severity was assessed by the urticaria activity score (UAS) and stress by Presumptive Stressful Life Events (PSLE) and Daily Hassles and Uplifts Scale-Revised (DHUS-R) scoring. IL-18 and high-sensitivity CRP (hs-CRP) were estimated using enzyme-linked immunosorbent assay kits and cortisol levels by chemiluminescence.
We observed significant systemic inflammation (increased hs-CRP and IL-18 levels) and stress scores, whereas there was a lowering of basal cortisol levels in patients with CU compared with controls. This finding was more pronounced with increasing disease severity and autoimmune disease, except for stress scores, which did not vary between patients with positive and negative autologous plasma skin test results. We further observed that patients with CU with hypocortisolism had higher levels of hs-CRP and IL-18 and higher PSLE and DHUS-R scores compared with those without hypocortisolism. The hs-CRP level, IL-18 level, PSLE score, DHUS-R score, and duration of the symptoms are significantly positively correlated with UAS, whereas the cortisol level is significantly negatively correlated with UAS. Cortisol has a significant negative correlation with PSLE score, DHUS-R score, and the duration of the disease.
CU is associated with systemic inflammation and stress, along with a significant lower basal cortisol, especially with severe disease and autoimmune urticaria. Thus, chronic stress may precipitate the vicious cycle in the pathogenesis of CU.
慢性荨麻疹（CU）是一种免疫介导的疾病，其特征为风团持续至少6周。压力的作用以及压力、皮质醇水平低下和炎症标志物之间的相关性尚未完全明确。
评估慢性荨麻疹患者的C反应蛋白（CRP）、白细胞介素（IL）-18和皮质醇水平，并探讨它们与疾病严重程度和压力的关联。
本横断面研究招募了45例慢性荨麻疹患者和45例年龄及性别匹配的健康对照者。通过荨麻疹活动评分（UAS）评估疾病严重程度，通过推定应激生活事件（PSLE）及修订版日常烦恼与愉悦量表（DHUS-R）评分评估压力。使用酶联免疫吸附测定试剂盒测定IL-18和高敏CRP（hs-CRP）水平，通过化学发光法测定皮质醇水平。
我们观察到慢性荨麻疹患者存在显著的全身炎症（hs-CRP和IL-18水平升高）和压力评分升高，而与对照组相比，其基础皮质醇水平降低。随着疾病严重程度和自身免疫性疾病的增加，这一发现更为明显，但压力评分在自体血浆皮肤试验结果为阳性和阴性的患者之间没有差异。我们进一步观察到，与无皮质醇水平低下的慢性荨麻疹患者相比，有皮质醇水平低下的患者hs-CRP和IL-18水平更高，PSLE和DHUS-R评分也更高。hs-CRP水平、IL-18水平、PSLE评分、DHUS-R评分和症状持续时间与UAS显著正相关，而皮质醇水平与UAS显著负相关。皮质醇与PSLE评分、DHUS-R评分和疾病持续时间显著负相关。
慢性荨麻疹与全身炎症和压力相关，同时基础皮质醇水平显著降低，尤其是在严重疾病和自身免疫性荨麻疹患者中。因此，慢性压力可能在慢性荨麻疹的发病机制中促成恶性循环。
