Handley J, Todd D, Dolan O, McMaster D, Walsh M, Allen G, Burrows D
Department of Dermatology, Royal Victoria Hospital, Northern Ireland, UK.
Contact Dermatitis. 1996 Feb;34(2):101-5. doi: 10.1111/j.1600-0536.1996.tb02138.x.
We previously showed the median duration of positive patch test reactions to nickel sulfate (5% pet.) was 9 days, and defined as long-lasting (LLAPTR) the 14.3% of reactions that persisted for 17 days or longer. The pathomechanisms of LLAPTR are unclear, but may involve either localized antigen persistence or abnormal downregulation of the cellular immune response. In this study, we compared (a) the nickel concentration and (b) the immunocytochemical nature of the local immune reaction, between biopsies from LLAPTR (n = 8) and normally resolving allergic patch test reactions (NRAPTR) (n = 8) to nickel sulfate. The concentration of nickel in LLAPTR (median 0.56 microgram/g, range 0.25-3.87 micrograms/g, mean 0.83 microgram/g, 95% CI 0.35-1.31) and NRAPTR (median 0.58 microgram/g, range 0.2-1.85 micrograms/g, mean 0.88 microgram/g, 95% CI 0.02-1.74) was similar. Activated T lymphocytes, expressing surface IL-2 receptor, HLA DR, DR alpha 1, DP, DQ, and CD2 > CD8 > CD4 antigens, were seen throughout the dermis and occasionally infiltrating the suprabasal layer of the epidermis in all biopsies. CD1 and HLA DR, DR alpha 1, DP, and DQ-expressing Langerhans cells were present throughout the epidermis and occasionally seen in the papillary dermis. HLA DR, DR alpha 1, DP, and DQ antigen expression were also seen on the surface of non-dendritic cells in the epidermis (probably either keratinocytes or T lymphocytes) and vascular endothelial cells in the papillary dermis. There were no significant qualitative or quantitative differences in the immunocytochemical nature of the localized immune reaction between LLAPTR and NRAPTR. These findings suggest that the pathomechanism of LLAPTR to nickel sulfate is unlikely to be explained simply on the basis of nickel concentration or the nature of the localized immune reaction at the patch test site.
我们之前发现，对硫酸镍（5% 凡士林）进行斑贴试验出现阳性反应的持续时间中位数为9天，并将持续17天及以上的14.3%的反应定义为持久反应（LLAPTR）。LLAPTR的发病机制尚不清楚，但可能涉及局部抗原持续存在或细胞免疫反应的异常下调。在本研究中，我们比较了LLAPTR（n = 8）和硫酸镍斑贴试验正常消退反应（NRAPTR）（n = 8）活检样本之间的（a）镍浓度和（b）局部免疫反应的免疫细胞化学性质。LLAPTR（中位数0.56微克/克，范围0.25 - 3.87微克/克，平均值0.83微克/克，95%置信区间0.35 - 1.31）和NRAPTR（中位数0.58微克/克，范围0.2 - 1.85微克/克，平均值0.88微克/克，95%置信区间0.02 - 1.74）中的镍浓度相似。在所有活检样本中，表达表面IL - 2受体、HLA DR、DRα1、DP、DQ以及CD2 > CD8 > CD4抗原的活化T淋巴细胞可见于整个真皮层，偶尔浸润至表皮的基底层上方。表达CD1以及HLA DR、DRα1、DP和DQ的朗格汉斯细胞存在于整个表皮层，偶尔可见于乳头层真皮。在表皮中的非树突状细胞（可能是角质形成细胞或T淋巴细胞）表面以及乳头层真皮的血管内皮细胞表面也可见HLA DR、DRα1、DP和DQ抗原表达。LLAPTR和NRAPTR之间局部免疫反应的免疫细胞化学性质在定性或定量方面均无显著差异。这些发现表明，LLAPTR对硫酸镍的发病机制不太可能仅基于镍浓度或斑贴试验部位局部免疫反应的性质来解释。
