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史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症(SJS/TEN)中组织病理学发现、血清生物标志物水平与临床结局的相关性。

Correlations between histopathologic findings, serum biomarker levels, and clinical outcomes in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN).

机构信息

Division of Dermatology, Department of Medicine, Chonburi Hospital, Ministry of Public Health, Chonburi, Thailand.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

出版信息

Sci Rep. 2023 Aug 21;13(1):13620. doi: 10.1038/s41598-023-40812-3.

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatological emergencies. The role of cytokines and chemokines in the pathogenesis, progression of the disease, and histopathologic features is not fully elucidated. To address this gap, we conducted a retrospective study examining the associations between 42 serum biomarkers, histopathologic findings, and clinical outcomes in SJS/TEN patients. We reviewed the medical records of 23 patients diagnosed with SJS/TEN. Regarding histopathology, our study did not reveal any significant associations between the degree of epidermal necrosis, dermal mononuclear cell infiltration, and clinical outcomes. However, an intriguing observation was made regarding the degree of dermal infiltration of CD8 + cells, which showed a negative correlation with the severity of acute ocular complications. Notably, serum levels of IFN-γ positively correlated with the number of CD8 + cells in dermal infiltration. Additionally, higher serum levels of myeloperoxidase were associated with greater degrees of epidermal necrosis, while serum Fas ligand and stem cell factor levels were elevated in individuals with increased dermal mononuclear cell infiltration. Furthermore, the levels of S100A8/A9 were significantly correlated with the SCORTEN and mortality rate. These findings provide insights into the intricate pathogenesis of the disease.

摘要

史蒂文斯-约翰逊综合征(SJS)和中毒性表皮坏死松解症(TEN)是严重的皮肤科急症。细胞因子和趋化因子在发病机制、疾病进展和组织病理学特征中的作用尚未完全阐明。为了解决这一差距,我们进行了一项回顾性研究,研究了 SJS/TEN 患者的 42 种血清生物标志物、组织病理学发现和临床结果之间的关联。我们回顾了 23 名被诊断为 SJS/TEN 的患者的病历。关于组织病理学,我们的研究没有发现表皮坏死、真皮单核细胞浸润的程度与临床结果之间有任何显著关联。然而,一个有趣的观察结果是真皮浸润的 CD8+细胞的程度与急性眼部并发症的严重程度呈负相关。值得注意的是,血清 IFN-γ 水平与真皮浸润中 CD8+细胞的数量呈正相关。此外,更高的血清髓过氧化物酶水平与更大程度的表皮坏死相关,而血清 Fas 配体和干细胞因子水平在真皮单核细胞浸润增加的个体中升高。此外,S100A8/A9 的水平与 SCORTEN 和死亡率显著相关。这些发现提供了对疾病复杂发病机制的深入了解。

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