Komatsu-Fujii Takayoshi, Chinuki Yuko, Niihara Hiroyuki, Hayashida Kenji, Ohta Masataka, Okazaki Ryota, Kaneko Sakae, Morita Eishin
Department of Dermatology, Shimane University Faculty of Medicine, Izumo, Japan.
Department of Laboratory Medicine, Shimane University Hospital, Izumo, Japan.
Allergol Int. 2018 Jan;67(1):90-95. doi: 10.1016/j.alit.2017.06.001. Epub 2017 Jun 22.
In severe drug eruptions, precise evaluation of disease severity at an early stage is needed to start appropriate treatment. It is not always easy to diagnose these conditions at their early stage. In addition, there are no reported prognostic biomarkers of disease severity in drug eruptions. The aim of this study was to test whether the thymus and activation-regulated chemokine (TARC) level in serum at an early stage of a drug eruption can serve as a prognostic biomarker of systemic inflammation.
Study participants included 76 patients who received a diagnosis of a drug eruption, one of the following: drug rash with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome, maculopapular exanthema, and erythema multiforme. Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) was eliminated in this study because scoring system for evaluating the severity was established. Correlation coefficients between serum TARC levels and indicators of systemic inflammation, including the neutrophil-to-lymphocyte ratio, Glasgow prognostic score, modified systemic inflammatory response syndrome (mSIRS) score, and C-reactive protein in serum were evaluated.
Serum TARC levels positively correlated with the neutrophil-to-lymphocyte ratio, Glasgow prognostic score, mSIRS score, C-reactive protein, albumin, white blood cell count, body temperature, and pulse rate. TARC levels negatively correlated with systolic blood pressure. Among these parameters, the mSIRS score showed strong correlation (correlation coefficient: 0.68).
Serum TARC levels correlate well with indicators of systemic inflammation and of disease severity among patients with a drug eruption except SJS/TEN. Serum TARC may be a prognostic biomarker of severity of inflammation in drug eruptions.
在严重药物疹中，需要在疾病早期精确评估疾病严重程度，以便开始适当治疗。在疾病早期诊断这些情况并非总是容易。此外，尚无关于药物疹疾病严重程度的预后生物标志物的报道。本研究的目的是测试药物疹早期血清中的胸腺和活化调节趋化因子（TARC）水平是否可作为全身炎症的预后生物标志物。
研究参与者包括76例被诊断为药物疹的患者，药物疹类型如下：伴有嗜酸性粒细胞增多和全身症状的药疹/药物性超敏反应综合征、斑丘疹、多形红斑。本研究排除了史蒂文斯-约翰逊综合征（SJS）/中毒性表皮坏死松解症（TEN），因为已建立了评估严重程度的评分系统。评估血清TARC水平与全身炎症指标之间的相关性，全身炎症指标包括中性粒细胞与淋巴细胞比值、格拉斯哥预后评分、改良全身炎症反应综合征（mSIRS）评分以及血清C反应蛋白。
血清TARC水平与中性粒细胞与淋巴细胞比值、格拉斯哥预后评分、mSIRS评分、C反应蛋白、白蛋白、白细胞计数、体温和脉搏率呈正相关。TARC水平与收缩压呈负相关。在这些参数中，mSIRS评分显示出强相关性（相关系数：0.68）。
除SJS/TEN外，药物疹患者血清TARC水平与全身炎症指标及疾病严重程度密切相关。血清TARC可能是药物疹炎症严重程度的预后生物标志物。
