Dienstag J L, Rhodes A R, Bhan A K, Dvorak A M, Mihm M C, Wands J R
Ann Intern Med. 1978 Jul;89(1):34-40. doi: 10.7326/0003-4819-89-1-34.
To determine whether skin deposition of circulating immune complexes contributes to prodromal urticaria of acute hepatitis B, we studied two patients with hepatitis B who presented with urticaria and fever. During the urticarial prodrome but not thereafter, we found activation of both classic and alternative complement pathways. Hepatitis B surface antigen (HBsAg)-antibody complexes were identified (by electron microscopy) in cryoprecipitates from both patients and IgG (by immunodiffusion) in cryoprecipitates of one patient during urticaria. Light and electron microscopy of involved urticarial skin revealed necrotizing venulitis in both patients. Immunofluorescence microscopy showed fibrin within involved cutaneous vessel walls in one patient and C3, IgM, and HBsAg, which were not detected in simultaneously obtained uninvolved skin, in both patients. Our findings suggest that deposition of circulating immune complexes containing HBsAg is important in the pathogenesis of urticaria associated with acute hepatitis B virus infection.
为了确定循环免疫复合物的皮肤沉积是否导致急性乙型肝炎的前驱性荨麻疹，我们研究了两名出现荨麻疹和发热的乙型肝炎患者。在荨麻疹前驱期而非之后，我们发现经典和替代补体途径均被激活。通过电子显微镜在两名患者的冷沉淀物中鉴定出乙肝表面抗原（HBsAg）-抗体复合物，在一名患者荨麻疹期间的冷沉淀物中通过免疫扩散鉴定出IgG。对受累荨麻疹皮肤进行光镜和电镜检查发现两名患者均有坏死性小静脉炎。免疫荧光显微镜检查显示，一名患者受累皮肤血管壁内有纤维蛋白，两名患者均有C3、IgM和HBsAg，而在同时获取的未受累皮肤中未检测到这些物质。我们的研究结果表明，含有HBsAg的循环免疫复合物的沉积在与急性乙型肝炎病毒感染相关的荨麻疹发病机制中起重要作用。
